Table 1.

Studies addressing barriers towards EBM in general practice

Study Year	Olantunbosun et al, 1998 [1]	Mc Coll et al 1998 [2]	McAlister et al 1999 [3]	Mayer et al 1999 [4]	Tomlin et al 1999 [5]
Population	Randomised sample of GPs and Gynaecologists in Canada	Randomised sample of GPs in Wessex, United Kingdom	Gps, members of the 'Canadian Society of Internal Medicine, Canada	Purposeful sample of GPs of educational programs, courses, supervisors of the 'Adelaide Royal Australian college of GPs', GPs from the Darwin Urban division of GPs, Australia	Purposeful sample of 8 practices of GPs in the North Tames region, members of the 'Medical Research Council General Practice Research Framework', United Kingdom
Design	Quantitative: Questionnaire	Quantitative: Questionnaire	Cross-sectional research: Questionnaire	Qualitative: Focus groups	Qualitative: Semi-structured interviews
Respondents	N = 154 GPs Response rate 78%	N = 452 Response rate 67%	N = 294 Response rate 60%	N = 27	N = 24
Barriers	Factors -Time consuming -Decrease of the art of medicine -Lack of evidence -Experience not taken into account	Factors -no skills in critical appraisal -EBM threatens GPs -Time consuming -No access to information -Organisational Chaos -No financial profits -Gaps in evidence -Evidence does not fit general practice -Too much evidence -Evidence hard to implement	Factors -Too academic -Decrease of the art of medicine -Movement still young -Gaps in evidence -not applicable to individual patient -Decrease of importance of experience	Factors -Reduction of therapeutic freedom -Contradictions in evidence -Not applicable in daily practice -Not applicable to individual patient -Studies too quantitative	Factors -lack of time -Lack of information sources -Lack of knowledge and skills -Too much pressure, less motivation -Evidence does not count complexity of situations in practice
	Actors Patients -erosion of autonomy	Actors Patients: -expectations do not fit EBM -does not except certain advice Colleagues: -Not evidence-based minded Government: -No investments Media: -Counterproductive messages		Actors Commercial organisations: -have influence on evidence Patients: -Do not count in terms of risks	Actors Patients: -No compliance -Specific cultural background -Specific values and knowledge -Behaviour GP = avoiding conflict -Clientism
Study Year	Scott et al 2000 [6]	Freeman et al 2001 [7]	Young et al 2001 [8]	Ely et al 2002 [9]	Putnam et al 2002 [10]
Population	Sample of members from the 'Internal Medicine Society', Australia and New Zealand, participants of an EBM-course program, doctors with a practice in 5 hospitals	Purposeful sample of GPs out of three regions concentrated around a hospital, United Kingdom	1. GPs, participants of a research project on preventive care, selection of those willing to participate, Australia	Sample of GPs in Iowa, United States	Purposeful sample of GPs with a minimum of one year experience, patients with cardiovascular problems, working in the region Nova Scotia, Scotland
Design	Quantitative: Questionnaire	Qualitative: 3 focus groups	1. Quantitative: Questionnaire 2. Qualitative: semi-structured interviews	Qualitative: observations	Qualitative: 9 focus groups
Respondents	N = 111 Response rate 20%	N = 19	N = 60	N = 25	N = 50
Barriers	Factors -Lack of time -No access to information -Problems in organisation -Lack of knowledge and skills -GPs not motivated -Not applicable to individual patient -Inconsequence in evidence	Factors -Lack of logistic support -Too many habitudes -Decrease of importance of experience	Factors -Lack of time -High cost of information sources -Lack of skills -Not applicable in daily practice -Evidence-Based acting = less patients an hour	Factors -Lack of knowledge and skills -Too less capacities to implement EBM in practice	Factors -Lack of time -Lack of competences -Evidence = dogma, confusing -Not applicable to individual patient -Decrease of importance of experience
		Actors Patients: -Does not accept certain advice -Specific characteristics -Asks for certain treatments -Do not always understand evidence-based message Colleagues: -Do not consider the patient in total -Specialist = evidence-based mafia	Actors Patients: -Asks for certain treatments -Specific expectations -Do not always understand evidence-based message		Actors Patients: -Brings info from internet -Not interested in EBM -Not enough competences to understand EBM -Creates uncertainty in the patient
Study Year	Al-Ansary et al 2002 [11]	Shawn et al 2003 [12]
Population	All GPs out of the region Riyadh, Saudi Arabia	GPs/participants of a national research program on the implementation of EBM,
Design	Quantitative: cross-sectional research, questionnaire	Qualitative: semi-structured interviews
Respondents	N = 559 response rate 86%	N = 15
Barriers	Factors -Lack of time -No access to information sources -Limited information sources -No high quality training programs available	Factors -Lack of time -Lack of information sources -No access to information sources -Lack of competences -Scientific studies not attractive -Decrease of the art of medicine -Decrease of clinical autonomy -Too much pressure -Inconsequence in evidence -Reliability and generalisation of scientific studies? -Not applicable in general practice -GPs actions based on intuition
	Actors Patients: -Specific attitude	Actors Patients: -Values and preferences of patients must be considered Colleagues: -Too less specialists working local Commercial organisations: -evidence sponsored by industry