• Translating trials into practice13,18,30 | • Knowledge of EBM15,26 | • Treatment expectations different from evidence25,31,33 | • Applicability of evidence to general practice13,14,17,18,22,24,27,30,34 |
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• Use of evidence is complicated23 | • Difficulty keeping up13,27 | • Adapting to preferences, beliefs, and demands different from evidence15,24,26,30,33 | • Lack of time:13–16,20,21,25,28–31,33 |
| | | • to search for evidence17,19,33 |
| | | • to access evidence19,26 |
| | | • to appraise evidence33 |
| | | • to apply evidence23 |
| | | • to keep up to date15–17 |
| | | • to discuss with patient33 |
| | | • per patient33 |
| | | • to reflect on practice26 |
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• Change of existing evidence15,19 | • Difficult to find information14,17,27 | • Reluctant to comply with treatment34 | • Lack of managerial support20,22,27 |
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• User-friendliness: need for summaries,14 also for better formats22,30 | • EBM skills14,15,19,24,30,31,33 | • GP's desire for patient's appreciation17 | • Lack of investment/incentives27,31 |
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• Lack of (qualitatively good) available evidence15,24,26,30,31,33 | • Attitude towards EBM15 | • Discussing with patient24 | • Fear of punishment or litigation:18,25 |
| • limited in treatment options and clinical freedom15,18,23,25 | • ‘convincing and pressure to meet | • EBM is a threat24,31 |
| | • expectations’17,26 | |
| • lack of interest/motivation32 | • ‘selling evidence to patients’17 | |
| • ‘EBM not helpful’16 | | |
| • ‘EBM will not benefit practice’27 | | |
| • in older people (less effort applying)13 | | |
| • lack of ownership/commitment13 | | |
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• Contradictions in evidence15,17,18,26,27,30 | • Lack of training20,25,32 | • Not accepting uncertainty of evidence18 | • Money needed:15,16,27,30,33 |
| • direction in training13,15,27 | | • for access to internet and resources26 |
| | | • EBM carries no financial gain27,31 |
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• Too much available evidence24,31 | • Personal and professional experiences different from evidence34 | • Confidence in GP reduced by guidelines25 | • Rural location26 |
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• Lack of resources14,15,26 | • Fear of side effects17 or harm19 | • Relationship between GP and patient34 | • Morale24 |
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• Available sources not helpful16 | • Harmonising guidance19,30 | • Experiences of the patient different from evidence34 | |
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• Access (computers, internet, journals, databases, or libraries)14,16,21,23–31 | • Practicalities of real life13,24 | • Toleration of uncertainties18 | |
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• Lack of trust in origin17,18 and in independence of evidence sources15 or information spread by other organisations (not evidence based)15 | • Lack of confidence19,30 | • Clinical symptoms, disease14 | |
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• Level of evidence22 | • Familiarity with new role15,26 | • Psychosocial context18,31 | |
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• Implications of the evidence22 | • Personal and organisational inertia24 | • Influence of media15,24 | |
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• The language in which evidence is written20 | • Culture29 | • Information retrieval by patient20 | |
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• Lack of help in interpretation by experts/specialists13,14,20 | • Influence of belief of peers19,24–26,31 | • Words of GP and presentation of information used by GP34 | |