|Year : 2018 | Volume
| Issue : 3 | Page : 850-854
Knowledge of evidence-based medicine among primary care physicians in Gharbia Governorate
Mohamed M Al-Kot1, Aml Salama1, Mohamed R Abdel Fattah2
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Ministry of Health, Tanta, Gharbia, Egypt
|Date of Submission||24-Jan-2017|
|Date of Acceptance||28-Mar-2017|
|Date of Web Publication||31-Dec-2018|
Mohamed R Abdel Fattah
Source of Support: None, Conflict of Interest: None
The aim of this study was to assess knowledge of primary care physicians regarding evidence-based medicine (EBM).
EBM is very important in the process of decision making, diagnosis, and treatment of patients. For years, medical schools have developed instructions for EBM to determine the knowledge of physicians towards EBM, to improve the practice of family physician with regard to EBM.
Participants and methods
This is a cross-sectional study. A total of 93 family physicians were selected randomly during their monthly meeting, which all attended. Physicians were included from rural and urban primary care centers using stratified random sampling in Gharbia Governorate. Study was conducted through a predesigned questionnaire for testing physician's knowledge regarding EBM. The main outcome measure was knowledge of physicians regarding EBM.
The response rate was 95.1%. Regarding the demographic characteristics of the studied group, the present study showed that female primary care and family physicians constituted a higher percentage (73.5%) than male physicians (26.5%). Of the 93 participants, there was a higher percentage of primary care and family physicians in the age group 20–29 years (59.2%) than in the age group 30–39 years (28.6%). Regarding the knowledge of family physicians for evidence-based, a higher percentage were somewhat knowledgeable (62.4%). Regarding the good total knowledge grading according to demographic characteristics, 71.1% of female physicians and 84.2% of physician working in family medicine unit had good knowledge grading.
This study was conducted to assess the knowledge of physicians and show improvement of knowledge regarding EBM.
Keywords: cross-sectional studies, evidence-based medicine, physicians
|How to cite this article:|
Al-Kot MM, Salama A, Abdel Fattah MR. Knowledge of evidence-based medicine among primary care physicians in Gharbia Governorate. Menoufia Med J 2018;31:850-4
|How to cite this URL:|
Al-Kot MM, Salama A, Abdel Fattah MR. Knowledge of evidence-based medicine among primary care physicians in Gharbia Governorate. Menoufia Med J [serial online] 2018 [cited 2019 Mar 25];31:850-4. Available from: http://www.mmj.eg.net/text.asp?2018/31/3/850/248770
| Introduction|| |
Evidence-based medicine (EBM) is defined as the ‘conscientious, explicit and judicious use of current best evidence’. The aim of EBM is to eliminate or reduce uncertainty in medical practice. EBM has emerged as a new paradigm for medical practice. Recent papers have highlighted the need for evidence-based family medicine. It has been suggested that strategies to promote change in clinical practice are more likely to be successful if they are based on an analysis of barriers and facilitators specific to the context. Many studies were conducted to assess the awareness of EBM in general practice (i.e., among family physicians). EBM is about asking questions, finding and appraising the relevant data, and harnessing that information for everyday clinical practice. The use of EBM in clinical practice is a key strategy to improve primary health care services. The aim of this study is to evaluate the knowledge of family physicians in Gharbia Governorate regarding EBM. No similar studies have been done among physician in Gharbia Governorate, and this is the first study to compare EBM among primary care physicians in Gharbia Governorate.
| Participants and Methods|| |
The study was approved by the Ethical Committee of the Faculty of Medicine; Menofiya University. This is a cross-sectional study. A total of 93 family physicians were selected randomly during their monthly meeting, which all attended. Physicians were included from rural and urban primary care centers using stratified random sampling in Gharbia Governorate. Study was through predesigned questionnaire for testing physicians knowledge regarding EBM, and its application in primary care physicians in Gharbia Governorate. The main outcome measure was knowledge of physicians toward EBM, regarding their ability to access and interpret evidence.
The study was conducted during the period from the first of October 2014 through the end of April 2015. A predesigned questionnaire was administered for testing physician's knowledge regarding EBM. Questions were explained in an easy language, and the researcher made sure that they understood each of the questions. The questionnaire consisted of 16 questions on personal data and 12 questions ranging from awareness of EBM to its medical terms. A total of 25 questions assessed the knowledge. Data collected from physicians included the following: sex, age group, years of practice as a family physician, highest degree attained in family medicine, working place, technical term of EBM know about EBM, interested to know more about EBM, aware of EBM journal, aware of Cochrane Database of Systematic Reviews, different types of the studies, and the source of their knowledge were also assessed. Each question was answered by ‘yes’ or ‘no’. The right answers were given a score of 1, whereas the wrong answers were given a score of 0, and the summation of scores was performed to assess the knowledge. Grading was based on score of true answers of the questions: good knowledge if the total score is more than or equal to 75%, fair knowledge if total score is 50%, and poor knowledge if the total score is less than 50%.
The data were tabulated and analyzed by statistical package for the social sciences program version 16 (SPSS Inc., Chicago, Illinois, USA) using a personal computer. Qualitative data were expressed as number and percentage and analyzed by c2-test. For comparing the same data, paired t-test was used. F-test (analysis of variance) is a test of significance for comparison between more than two quantitative variables with different variance with determination of the least significant difference. Level of significance was set at P less than 0.05.
| Results|| |
The response rate was 95.1%. Regarding the demographic characteristics of the studied group, the present study showed that female primary care and family physicians (73.5%) constituted a higher percentage than the male counterparts (26.5%). Moreover, a higher percentage of primary care and family physicians were in the age group 20–29 years (59.2%) than in the age group 30–39 years (28.6%). A higher percentage of physician had the qualification of a diploma (69%) than master's degree (9%), fellowship (3%), and MBBCh (16%). Regarding the position of work of the studied group, there was a higher percentage of general practitioners (66%) than residents (26%) and specialists (8%) [Table 1].
Of the 93 respondents, a higher percentage of family physician worked in a family medicine unit (83.7%) than in a family medicine center (16.3%); moreover, 76.5% were from rural areas and 12.2% were from urban areas, and 87.8% stated home as their main source of internet access (87.8%) rather than clinic (6.1%).
Regarding the knowledge of EBM in the study group, most of the physician (62.4%) were somewhat knowledgeable than not knowledgeable (10.8%) [Table 2].
|Table 2: Knowledge of the studied group regarding evidence-based medicine|
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The grading of knowledge according to demographic characteristics of the studied group regarding EBM is as follows: males who had good total knowledge grading represented 28.9%, whereas female who had good total knowledge grading constituted 71.1%, which is a higher percentage than males; a higher percentage of those in the age group 20–29 years (50%) had good total knowledge grading than those in the age group 30–39 years (18.4%). Regarding the knowledge grading according to the highest degree attained in family medicine, a higher percentage of fellowship physicians had good total knowledge grading (42.1%) compared with those with master's degree with good knowledge grading (21.1%), as shown in [Table 3].
|Table 3: Knowledge grading according to demographic characteristics of the studied group|
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Regarding good knowledge grading among physicians, those who worked in rural areas had higher grading (84.2%) than those in urban areas (7.9%); those who worked in family medicine unit (84.2%) had higher grading than those who worked in family medicine center (15.8);general practitioners had higher grading (57.9%) than specialist family physician (7.9%); and those who had access to the Internet at home had higher grading (78.9%) than those who had access to the internet at clinic (13.2%), as shown in [Table 4].
|Table 4: Knowledge grading according to demographic characteristics of the studied group|
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| Discussion|| |
This is a cross-sectional study conducted in Gharbia Governorate and presents data on knowledge of primary care physicians regarding EBM. Of the 93 family physician, 76.5% were from rural areas and 12.2% were from urban areas. Regarding the sex of the physicians, 26.5% were males and 73.5% were females. The age group between 20 and 29 years constituted 59.2% of the studied group.
In a study conducted in Jordan, the response rate was 70.5%. Among those who responded, 56.7% were women and 42.6% were between the ages of 40 and 49 years. More than 50% of the respondents were working in mixed urban and rural practice settings. The study shows high attendance in the age group of 40–49 years (42.6%). This study shows statistical significant difference in knowledge of family physicians regarding EBM.
In their study with respect to the highest degree in family medicine regarding good knowledge, physicians who had fellowship represented the most with 40%, whereas parameters such as age, sex, years of practice, site of work, and participations in continuing medical education program constituted no statistical significant difference.
Another response from a family physicians was ‘EBM gives similar care to the patient with equal benefits and less harm’. Participants used internet-based resources, books, and journals for updating their knowledge.
In a study conducted in Riyadh, most respondents (42.6%) thought that the best way to move from opinion-based medicine to EBM was by learning the skills of EBM, whereas 37.0% thought it should be by using evidence-based guidelines or protocols. In contrast, the largest proportion of PHC physicians (57%) in McColl's study in the UK thought that the most appropriate way to apply EBM was by using evidence-based guidelines or protocols, whereas 37% thought it should be by seeking and applying evidence-based summaries and only 5% thought that it should be by identifying and appraising the primary literature or systematic reviews.
The absence of a library in the locality, the long travel distances to reach the nearest library, and limited resources and facilities are barriers to EBM. Limited resources are in the form of lack of computers in addition to deficient Internet access in the workplace. In this study, those with good knowledge of EBM have access to the internet from home (78.9%), from clinic (13.2%), and from library (7.9%).
This result agreed with a study done in Doha, Qatar, where most of the physicians had access to the internet (92.2%), but this was usually from home. More than one-third of the physicians (35.0%) were reading journals on demand and another one-third (34.6%) were reading them regularly; 28.0% read them occasionally, and only a few physicians reported never reading journals (2.2%).
There was limited access to online journals because few physicians had access to journal subscriptions. Lack of availability of books, especially up-to-date ones, in many of the specialties was also seen as a major barrier. Most of the respondents in our study had access to the internet, but for most, this was at home and not the workplace. This may explain the low rate of practicing EBM. The internet promotes the practice of EBM by facilitating the generation, synthesis, dissemination, and exchange of research evidence. This finding is in agreement with a study done in Canada which shows that internet-based tool helps clinicians to produce short summaries of articles on clinically relevant topics. These summaries are known as ‘critically appraised topics’. Providing physicians with cheap, fast, and efficient access to up-to-date, valid, relevant, and ‘just-in-time’ knowledge is essential. Lack of EBM training courses and workshops was also seen as a barrier to knowledge of EBM by physicians in Gharbia Governorate. The most appropriate way to move from opinion-based medicine to EBM is through focusing on training in the critical appraisal of research. It was found in the Riyadh study that most of the respondents (42.6%) thought that the best way to move from opinion-based medicine to EBM was by learning the skills of EBM, whereas 37.0% thought it should be by using evidence-based guidelines or protocols. In contrast, the largest proportion of PHC physicians (57%) in McColl's study in the UK thought that the most appropriate way to apply EBM using evidence-based guidelines or protocols, whereas 37% thought it should be by seeking and applying evidence-based summaries and only 5% though it should be by identifying and appraising the primary literature or systematic reviews. It has been suggested that if clinical practice guidelines are incorporated into electronic medical record systems to assist clinical decision making at the point of care, it may greatly enhance the delivery of evidence-based clinical practice. Regarding the overall knowledge of the studied group regarding EBM, a higher percentage of physicians constituted those who were somewhat knowledgeable (62.4%) than those who were not knowledgeable (10.8%). All of the physicians had textbooks and journals as their first preference as a source of knowledge. The most easily accessible electronic resource available to participants was the internet.
| Conclusion|| |
This study was the first to consider knowledge of physicians regarding EBM in Gharbia Governorate in Egypt and was the first to compare EBM according to various characteristics among primary care physicians. This study was conducted to assess the knowledge regarding EBM. The results of this study show improvement of the knowledge of the studied group. It is recommended to provide education regarding EBM to all physicians, especially through implementation of evidence-based guidelines, to improve overall knowledge and the health care system.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn't. Br Med J 1996; 312
Mears R, Sweeney K. A preliminary study of the decision-making process within general practice. Fam Pract 2000; 17
Ridsdale L. Evidence-based learning for general practice. Br J Gen Pract 1996; 46
Grol R, Grimshaw J. Evidence-based implementation of evidence-based medicine. Jt Comm J Qual Improv 1999; 25
McColl A, Smith H, White P, Field J. General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey. Br Med J1998; 316
Chalmers I, Dickersin K, Chalmers TC. Getting to grips with Archie Cochrane's agenda. Br Med J 1992; 305
Hickie I, Groom G. Primary care-led mental health service reform: an outline of the Better Outcomes in Mental Health Care initiative. Australas Psychiatry 2002; 10
Barghouti F, Halaseh L, Said T, Mousa AH, Dabdoub A. Evidence-based medicine among Jordanian family physicians: awareness, attitude, and knowledge. Can Fam Physician 2009; 55:
Al-Ansary LA, Khoja TA. The place of evidence-based medicine among primary health care physicians in Riyadh Region, Saudi Arabia. Fam Pract 2002; 19
Al-Kubaisi NJ, Al-Dahnaim LA, Salama RE. Knowledge, attitudes and practices of primary health care physicians towards evidence-based medicine in Doha, Qatar. East Mediterr Health J 2010; 16
Jadad AR, Haynes RB, Hunt D, Browman GP. The internet and evidence-based decision-making: a needed synergy for efficient knowledge management in healthcare. CMAJ 2000; 162
Hirst GH, Ward JE. Clinical practice guidelines: reality bites. Med J Aust 2000; 172
[Table 1], [Table 2], [Table 3], [Table 4]