推行實證醫學之障礙：醫師之認知與態度

Physician's Perceptions and Attitudes Toward Evidence-based Medicine and Barriers to Its Implementation

陳重榮(Trong-Zong Chen) ； 劉秀雯(Shiow-Wen Liou) ； 祝春紅(Chun-Hong Chu)

《北市醫學雜誌》 2卷2期 (2005/02) Pp. 183-192

https://doi.org/10.6200/TCMJ.2005.2.2.08

摘要

Objective: Ten years have elapsed since the advocacy of evidence-based medicine (EBM). To understand physician's perceptions and attitudes to EBM and the barriers to implementation in a regional hospital in Taipei city, a questionnaire survey was performed. Methods: From February 2003 to April 2003,87 physicians received a questionnaire which including the characteristics of the physicians, their perceptions, their acceptance and application of EBM, their willingness to implementing EBM, their views on the barriers to practicing EBM and their views on how best to move forward with EBM. The demographic data is presented with descriptive statistics. The Student's t test, the Pearson correlation test and stepwise multiple regression were used for inference statistics. A p value of less than 0.05 was considered to be significant. Results: A response rate of 79.3% (69/87) was achieved. Of the 69 respondents, 43 (62.3%) were male and 26(37.7%) were female. Among these, 42 (60.9%) were faculty physicians and 27 (39.1%) were resident physicians. Most respondents welcomed EBM, and believed their colleagues to be less welcoming. The difference in the level of welcoming of EBM between the two groups reached significance. Most physicians agreed that research results were useful in the management of patients and practicing EBM would improve patient care. The median value for the estimated percentage of the physician's clinical practice that was evidence based was 70%. Female physicians had a higher agreement than male physicians that practicing EBM was another demand on an already heavy workload. The perceived barriers to practicing EBM were as follows in order of belief: patient's expectations; lack of personal time; lack of routine practice of EBM; difficulties in involving the whole practice and the lack of hard evidence. Most respondents (65.6%) thought that the most appropriate way to move from opinion based practice to evidence based medicine was to use evidence based guidelines and protocols developed by colleagues or the seeking and applying of evidence based summaries. Conclusion: Most respondents had positive attitudes towards EBM. To eliminate the barriers to the implementation of EBM, the institute should enhance healthcare education based on evidence and also increase and improve accessibility to EBM-related databases to minimize the time spent searching for evidence. Promoting the development of consensus guidelines by colleagues and the greater application of evidence based summaries would be helpful to physicians who practice EBM in regional hospitals.

關鍵字

實證醫學 ； 認知 ； 態度

並列摘要

Objective: Ten years have elapsed since the advocacy of evidence-based medicine (EBM). To understand physician's perceptions and attitudes to EBM and the barriers to implementation in a regional hospital in Taipei city, a questionnaire survey was performed. Methods: From February 2003 to April 2003,87 physicians received a questionnaire which including the characteristics of the physicians, their perceptions, their acceptance and application of EBM, their willingness to implementing EBM, their views on the barriers to practicing EBM and their views on how best to move forward with EBM. The demographic data is presented with descriptive statistics. The Student's t test, the Pearson correlation test and stepwise multiple regression were used for inference statistics. A p value of less than 0.05 was considered to be significant. Results: A response rate of 79.3% (69/87) was achieved. Of the 69 respondents, 43 (62.3%) were male and 26(37.7%) were female. Among these, 42 (60.9%) were faculty physicians and 27 (39.1%) were resident physicians. Most respondents welcomed EBM, and believed their colleagues to be less welcoming. The difference in the level of welcoming of EBM between the two groups reached significance. Most physicians agreed that research results were useful in the management of patients and practicing EBM would improve patient care. The median value for the estimated percentage of the physician's clinical practice that was evidence based was 70%. Female physicians had a higher agreement than male physicians that practicing EBM was another demand on an already heavy workload. The perceived barriers to practicing EBM were as follows in order of belief: patient's expectations; lack of personal time; lack of routine practice of EBM; difficulties in involving the whole practice and the lack of hard evidence. Most respondents (65.6%) thought that the most appropriate way to move from opinion based practice to evidence based medicine was to use evidence based guidelines and protocols developed by colleagues or the seeking and applying of evidence based summaries. Conclusion: Most respondents had positive attitudes towards EBM. To eliminate the barriers to the implementation of EBM, the institute should enhance healthcare education based on evidence and also increase and improve accessibility to EBM-related databases to minimize the time spent searching for evidence. Promoting the development of consensus guidelines by colleagues and the greater application of evidence based summaries would be helpful to physicians who practice EBM in regional hospitals.

並列關鍵字

evidence based medicine ； perception ； attitude