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Barriers and Enhancers to the EBM process

Barriers and Enhancers to the EBM process. 12 th June, 2007. Jane McHugh, Information Specialist Dr Klara Brunnhuber, Clinical Editor BMJ Publishing Group Ltd. Agenda. EBM process: From unrecognised information need to evidence-based practice Enhancers and barriers to EBM process

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Barriers and Enhancers to the EBM process

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  1. Barriers and Enhancersto the EBM process 12th June, 2007 Jane McHugh, Information Specialist Dr Klara Brunnhuber, Clinical Editor BMJ Publishing Group Ltd.

  2. Agenda • EBM process: From unrecognised information need to evidence-based practice • Enhancers and barriers to EBM process • Role of clinical librarian services within EBM process

  3. Methods • In-depth data analysis of the papers identified by M. Dawes’ systematic review* • Recording barriers and enhancers to the EBM process • Grouping barriers / enhancers by SPECK concepts • Mapping clinical librarian services to the EBM process *Dawes M. Sampson U. (2003) Knowledge management in clinical practice: a systematic review of information seeking behaviour in physicians. Int J Med Inform. 71: 9-15.

  4. EBM Process

  5. Results based on Dawes’s review: Number of studies included Quantitative analysis in review

  6. SPECK concepts

  7. Enhancers and barriers to the EBM process No. of studies Based on Dawes’s review (2003) E: Enhancer; B: Barrier; *: Perceived enhancer/barrier

  8. RESULTS POSSIBLE ENHANCERS POSSIBLE BARRIERS Step 0: • S: Exposure to questions/ • problems (from seniors, • colleagues, training, • exams) • E: Journal subscription • S: Working in isolation • C: Existing thinking • patterns • C: Loosing face in front of • juniors • C: Lack of time Step 1:

  9. RESULTS POSSIBLE BARRIERS POSSIBLE ENHANCERS Step 1: • C: Forgetfulness • C: Lack of time • C: Lack of skill to • formulate questions Step 2:

  10. POSSIBLE BARRIERS POSSIBLE ENHANCERS • S: Dealing with many specialty areas • S: Lack of access to resources • S: Lack of time due to urgency of • decision • S: Messy office • P: Question too general • P: Lack of urgency • C: Lack of time • C: Lack of search skills • C: Lack of knowledge about resources • C: Forgetfulness • C: Belief that resource won’t deliver • answer • C: Belief that answer won’t change • patient management • C: Belief that no answer exists • C: Perceived effort • C: Hesitation to contact colleagues • C: Lack of interest • C: Lack of energy due to long working • hours • C: Lack of computer literacy • K: Huge volume of literature • K: Cost of resources • P: Urgency of need • E: Search skill training • C: Belief that answer exists • C: Belief that patient will be harmed • without answer • C: Belief that patient expects answer • C: Belief that patient expects doctor to • know answer • C: Fear of malpractice liability • C: Recently trained, with academic • appointment, involved in research, • member of journal club • K: Access to full text articles* • K: Easy, fast access to reliable, • trustworthy, familiar, convenient, • searchable extensive/complete • resource/service • K: Ideal resource*: Immediate, easily • accessible, concise, organised, high- • quality information, answering specific • questions, usable in patient’s presence, • more than just a list of references Step 2: Step 3: also covered by Dawes’s review

  11. POSSIBLE BARRIERS POSSIBLE ENHANCERS • E: Slow/inconvenient IT systems • C: Lack of appraisal skills • C: Lack of time • C: Time available*: 10-30min • for research questions; less • for clinical questions • C: Difficulty finding relevant • material • K: Resource out of date/of low • quality • K: Lack of access to good images • K: Technical language of • material • K: Inadequate indexing of • material • K: Answer not concise enough to • address point-of-care • questions • K: Answer delayed Step 3: • E: Info on resources from • colleagues/training • E: Critical appraisal training • K: High quality, credible, • easily understandable • resource, providing all • necessary detail Step 4:

  12. POSSIBLE BARRIERS POSSIBLE ENHANCERS Step 4: • E: Answer confirmed by • additional literature search • E: Opportunity to discuss • answer with colleagues/ • someone who has applied • it/at journal club • C: Reported results compare • well with experience • K: Peer-reviewed article • S: Inadequate local resources • C: Existing working/thinking • patterns and habits Step 5:

  13. Current clinical librarian services • Encouraging questioning/learning culture and a greater willingness to check out the evidence as part of everyday patient care • Involvement in journal clubs, delivering EBM skills • Current awareness services / bulletins • Attending ward rounds/clinical meetings • Training how to formulate questions • Question Answering Services • Training how to search • Question Answering Services • Collating and grading results against evidence hierarchy • Setting up databases of answered clinical questions • Training how to appraise articles • Requesting feed back on provided services • Following up on service’s impact on clinical care

  14. Next steps • Update of Dawes’ SR (special focus on electronic knowledge resources) • Additional search covering the last EBM step (putting EBM into clinical practice)

  15. Thank you • Jane McHugh jmchugh@bmjgroup.com • Klara Brunnhuber kbrunnhuber@bmjgroup.com

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