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Independents' Day

GPs face huge barriers applying new evidence

By Daniel Cressey

GPs are lobbying the Government to restore access to the respected Drug and Therapeutics Bulletin in the wake of a fresh illustration of the barriers they face in adopting evidence-based medicine.

A new study found GPs were far less likely than hospital doctors to incorporate new evidence into practice, and faced a host of difficulties finding the time and resources to keep themselves up to date (see box, below).

The new research, published in the Journal of Evaluation in Clinical Practice, found GPs were struggling to apply evidence-based medicine, with 27 per cent saying they never critically appraised the literature, compared with 10 per cent of hospital doctors.

Only 20 per cent of GPs frequently integrated evidence with expertise, whereas 38 per cent of hospital doctors did so.

The RCGP has written to ministers to protest at the decision to end centralised funding to the DTB ­ one of the few evidence-based resources GPs can readily access.

And doctors have expressed their outrage at the move en masse, with the DTB claiming to have received more than 2,000 letters already, which were also being sent on to the Department of Health.

Dr Arnold Zermansky, a GP in Leeds and one of the many to have written to Health Secretary Patricia Hewitt, said: 'DTB is one of the few sources of dispassionate, reliable, evidence-based prescribing information.'

Dr Mayur Lakhani, RCGP chair, told Pulse the college had 'noted the concerns' of GPs. 'We have written to ministers expressing our concern.'

Dr Ike Iheanacho, DTB editor, said: 'We've had just over 2,000 people who have written to us and also to Patricia Hewitt to complain about the decision. A lot of them are annoyed and making the very point about how it is going to be much more difficult for them to keep up to date.'

Penney Upton, a researcher on the new study and research associate at the department

of psychology, University of Sheffield, said GPs needed support to integrate evidence into practice.

'GPs know about evidence-based medicine but they don't have the time to put it into practice,' she said.

'It may simply be because they don't get to practise the skills very often. That and maybe a lack of confidence,' she added.

Barriers to evidence-based practice

Easy/% Uncertain/% Difficult/%

Obtaining GPs 17 38 46

money Hospital 54 20 26


Time GPs 36 12 52

Hospital 60 11 29


Access to GPs 53 11 36

library Hospital 86 5 9


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