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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR65

A survey of attitudes and knowledge of evidence-based medicine in secondary care

By A. E. Edwards and M. Regina Brophy*

Introduction Evidence-based medicine (EBM) is spoken about widely by many health care professionals who claim to be practising it. There is much information available and with the National Health Service drive for quality and clinical governance,1 it is increasingly important that health care professionals know how to access, interpret and apply such knowledge.2 A survey had been carried out on general medical practitioners (GPs) in the Wessex region3 to establish their perceptions of the route to evidence-based medicine. It was therefore decided to assess the level of awareness and attitudes of staff in secondary care to evidence-based medicine.

Method A questionnaire adapted from McColl et al3 was used to obtain information on demographic characteristics, attitudes towards EBM, awareness of evidence-based resources, accessibility of evidence, understanding of terms used in EBM and general views. A mixture of visual analogue scales, closed questions and open questions were used.
The questionnaire was sent to senior medical, nursing and pharmacy staff (n=110, 49 consultants, 36 F and G grade nurses, and 25 B-H grade pharmacists). A covering letter was also included to outline the background and to ensure anonymity.

Focal points

  • Doctors, nurses and pharmacists welcomed evidence-based medicine (EBM)
  • There is a need for training in EBM for clinicians regardless of seniority
  • The main perceived barriers to EBM were lack of time and, to a lesser extent, lack of available evidence and poor availability and access to databases
  • Pharmacists need training in EBM and to change management if they are to promote evidence-based practice

Results Sixty-nine questionnaires were returned (63 per cent), with similar response rates from the three professions and covering a broad range of specialities. The medics were predominantly male and both nurses and pharmacists largely female. The age ranges were as follows: 41-50 (42 per cent); 31-40 (28 per cent), 21-30 (10 per cent), 51-60 (8 per cent).
Most respondents welcomed EBM. Furthermore, they agreed that its practice improved patient care and that research findings were useful in the day to day management of patients. Interestingly, 80 per cent of all clinicians responding claimed to be using EBM although only 21 per cent used EBM databases or journals in clinical decision making.
Table 1 shows an indication of the respondents' knowledge in EBM.
Table 1

There was a trend in favour of the use of guidelines and protocols to facilitate EBM (40 per cent). A large number also wanted to learn the skills of EBM and to search for and apply evidence-based summaries.
The major perceived barrier to practising EBM was a lack of time. Poor availability and access to databases and lack of evidence itself was also perceived as a barrier.

Discussion Promoting the practice of evidence-based medicine in a secondary setting requires further education for all clinicians regardless of seniority. There was a discrepancy between the respondents' claims to practising EBM and actual understanding of the terms used or training in EBM. The 34 per cent of non-responders may also be camouflaging poor knowledge. The strategy used for education will itself need to be evidence-based.
The results of the study have been flagged up to hospital management in an effort to get support for EBM education in the trust. Further, pharmacists will need to learn the skills of EBM and change management if they are to promote evidence-based practice.

Acknowledgment: We would like to acknowledge Patrick Hill, clinical psychologist, Royal United Hospital, Bath for help in this study.

School of pharmacy, University of Bath; *Royal United Hospital NHS trust, Bath

References

1. Department of Health. A first class service-quality in the new NHS. London: Stationery Office; 1998.
2. Sackett DL, Richardson, WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. London: Churchill Livingstone; 1997.
3. McColl A, Smith H, White P, Field J. General practitioners' perceptions of the route to evidence-based medicine: a questionnaire survey. BMJ 1998;316:361-5.