Is primary care evidence-based in Turkey? A cross-sectional survey of 375 primary care physicians

Objective: Family medicine (also called general practice) is a specialty with a focus on primary care. In Turkey, not all primary care is provided by specialists. Efforts are underway to improve primary care by improving the provision of primary care, establishing referral chains, and having care provided by general practitioners after transition training or by family medicine specialists. We investigated the relationship between evidence-based medicine (EBM) and primary care in Turkey, to provide a snapshot of the current situation and baseline data to assess the effects of current and future reforms.

Methods: A cross-sectional survey was done of 375 primary care physicians: 138 general practitioners (GPs), 121 family medicine (FM) trainees, and 116 FM specialists. They were asked 30 questions assessing general characteristics, knowledge, and training in EBM; general attitudes towards EBM; resources used to support clinical decisions; possible barriers to EBM practice; and opinions on future practice of EBM. Data were analyzed with SPSS 12.0.

Results: Compared with the other physicians, FM specialists had significantly more Internet access, used the Internet for medical purposes more often and for longer hours, had published more scientific papers, searched MEDLINE or similar databases more often, and were more confident about conducting literature searches. FM specialists had significantly higher rates of training in EBM and critical appraisal. For all types of physicians surveyed, the main reported barrier to practicing EBM was lack of training in EBM.

Conclusions: Attitudes toward EBM differ significantly between GPs and FM specialists working in primary care in Turkey, which we believe results in variation in medical provision. The differences between these two groups of physicians should be investigated further, and means of improving the provision of care should be reported to policy makers.