. 2012 Jun 25;62(600):e511–e521. doi: 10.3399/bjgp12X652382

Table 3.

Barriers to the use of evidence-based medicine (EBM) by GPs

Evidence	GP's preferences	Patient's situation	Practice setting
• 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

• 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

• Change of existing evidence¹⁵^,¹⁹	• Difficult to find information¹⁴^,¹⁷^,²⁷	• Reluctant to comply with treatment³⁴	• Lack of managerial support²⁰^,²²^,²⁷

• 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

• 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

• 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

• Too much available evidence²⁴^,³¹	• Personal and professional experiences different from evidence³⁴	• Confidence in GP reduced by guidelines²⁵	• Rural location²⁶

• Lack of resources¹⁴^,¹⁵^,²⁶	• Fear of side effects¹⁷ or harm¹⁹	• Relationship between GP and patient³⁴	• Morale²⁴

• Available sources not helpful¹⁶	• Harmonising guidance¹⁹^,³⁰	• Experiences of the patient different from evidence³⁴

• Access (computers, internet, journals, databases, or libraries)¹⁴^,¹⁶^,²¹^,²³^–³¹	• Practicalities of real life¹³^,²⁴	• Toleration of uncertainties¹⁸

• 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

• Level of evidence²²	• Familiarity with new role¹⁵^,²⁶	• Psychosocial context¹⁸^,³¹

• Implications of the evidence²²	• Personal and organisational inertia²⁴	• Influence of media¹⁵^,²⁴

• The language in which evidence is written²⁰	• Culture²⁹	• Information retrieval by patient²⁰

• 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