BERKELEY, CA (UroToday.com) - In the June, 2008 issue of the Journal of Urology, Dr. Charles Scales and colleagues reported on urologists’ perceptions of barriers to implementing evidence-based medicine (EBM) in urology. EBM is the concept that patient care should involve the best available evidence with individual patient circumstances, preferences and values.

In 2005, the investigators surveyed the opinions and attitudes of AUA members toward EBM. The survey had four main components, including awareness and use of important sources of primary and synthesized evidence, perceived understanding of EBM related terminology, and demographic characteristics. Topics such as EBM awareness, use, and understanding were accompanied by Likert-type scales. Categorical demographic characteristics were collected. There was also an open-ended question about perceived barriers to the implementation of EBM in urology. Of the 506 survey respondents, 365 (72.1%) provided an answer for this question. In this report, two raters developed the coding scheme of physician factors, patient factors, system level factors, issues with the evidence, and other barriers. One rater assigned a category to each response. The second rater coded a random 20% of the responses to establish inter-rater reliability.

Among the initial survey results, respondents believed that they mostly practiced EBM, but didn’t think other urologists did. Among the 365 participants who responded to the open-ended question, 89% were male, 71.6% practiced in the community and 37.2% were fellowship trained. A concern over the evidence was cited by 52.9% of respondents as the most common barrier to practicing EBM. Lack of evidence was the most common concern (cited by 22%) with “lack of good evidence for most areas of urology” a typical response according to the authors. Other concerns were poor study quality (11%) and poor applicability (7.7%). System level variables were reported in 37% of responses as being barriers. Third-party payers (10.1%) were the most frequent barriers in this group. Many were concerned about the risk of litigation as a barrier to EBM. In the survey, 28.2% listed physician factors - with a lack of time being most common. With less frequency, patient factors (9.3%) such as a patients’ desires not correlating with EBM were cited. Only 4.9% of respondents cited no barriers to practicing EBM.

Scales CD Jr, Voils CI, Fesperman SF, Sur RL, Kübler H, Preminger GM, Dahm P

J Urol 2008;179:2345-50
10.1016/j.juro.2008.01.109

PubMed Abstract
PMID: 18423732

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Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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