| Project Objectives / Summary:
The project aimed to promote evidence based medicine (EBM) to general practitioners. It established a sustainable Divisional system to support GPs to overcome barriers to the use of the best available evidence in clinical decision making. The model was based on three independent phases:
- Increasing GP understanding of the principles of evidenced based practice (EBP) which includes the framing of answerable questions, searching for evidence, appraising it and applying it. Three common and important clinical areas (cardiovascular disease prevention, antibiotic prescribing for sore throat and otitis media, and cancer screening - breast, cervix, bowel and prostate) provided a context for this upskilling program.
- The Division developed a system to support GPs who wished to examine barriers to practising EBP and work with them to develop strategies to overcome such barriers.
- Exploration and piloting of the early development of a quality improvement program for GPs that incorporate the principles of EBP into a continuous cycle of clinical practice improvement.
Evaluation was achieved through three mechanisms:
1. Feedback sheets from GPs;
2. A study on the impact of academic detailing using a questionnaire in a randomised controlled design; and
3. Key informant interviews with six GPs at the end of the project.
The academic detailing lasted 25 - 40 mins and included an overview of EBM and an exploration of what might be the next step for each GP to take 'down the road to EBM'. The Project Officer academically detailed 72 GPs out of a total of 132 in the Division. An average of 18 GPs attended each of four two hour workshops.
Project Collaboration:
- Monash Institute of Public Health
- Centre for Clinical Effectiveness, Monash Medical Centre
- Department of Environmental Science, Monash University
Project Outcomes:
The project was able to meet all its original objectives apart from those which were scheduled for the second year, that is, Continuous Quality Improvement (CQI) program (and promotion and further development and evaluation of the project). Evidence of such is found in the dissemination component of this report particularly in the resources developed.
Evaluation revealed a high level of satisfaction with both the academic detailing and workshops. Academic detailing had an impact on GPs knowledge about EBM but not their attitudes to it. The kit and desktop guide were found to be useful.
Recommendations:
- Need to embed new conceptually based topics in the clinical framework to ensure GPs take an active role in their adoption.
- To attract GPs to Evidence Based Practice, it is important to emphasise the practical and time efficient aspects and not just the academic fundamentals.
- Multiple approaches, rather than one method have a greater chance of success.
- Divisions have a key role in supporting GPs in their quest to not only to keep up to date but also to make the most out of the information available, and to promote the uptake of research results into practice.
Disseminating Project Information:
Publications:
- 3 articles published in the monthly newsletter of the Division.
- Email bulletins to 55 GPs
- The impact of the academic detailing on GP's knowledge attitudes and practice of EBM, Family Physician (UK)
- Convergence of EBM and IT, Medicine Today (November 2000)
- The effectiveness of strategies to promote change in the clinical behaviour of GPs, Australian Family Physician
- Continuous Quality Improvement in General Practice, Australian Family Physician
Resources:
- GP Resource Kit distributed to all Division GPs
- Laminated Desk Top Guide distributed to all Division GPs
- Division Kit - distributed to all divisions nationally
- CME policy
Website:
- A Monash Division EBM website was produced in December 1999.
Presentations:
- The project only made a start with the development of its program of Continuous Quality Improvement (CQI) which had originally been planned for more vigorous promotion in its second year. The preliminary work included a literature search and an introductory presentation about CQI to GPs attending the regular Divisional CME activity.
- Presentation to the Division's Program Advisory Group and the Journal Club at the Department of General Practice Monash University.
Lessons / Assessment:
- A well coordinated project with open, honest, and continuous communication between the main coordinators. This approach has led to the development of a very successful project that has potential benefit to all Divisions who wish to utilise it.
- The project confirmed that the teaching of EBM should be embedded within the clinical context and that the practical more than academic aspects of EBM should be stressed when encouraging GPs to take up EBM. Active participation by GPs and a variety of educational methods are important in ensuring the successful promotion of EBM.
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