Table 2.

Barriers to uptake of evidence.

Intervention/ study design based	Use of surrogate end-points which may not be clinically relevant
	Inconsistent clinical trial results
	Complex or costly intervention only available in academic centers or requiring high level of staff expertise
	Results not applicable to the general population because of selection bias in the trials
Clinician based	Lack of knowledge of evidence
	Lack of motivation/ Clinical inertia to change practice
	Disagreement with results
	Beliefs about lack of feasibility of the intervention
Patient based	Preference/ expectations/ knowledge
System based	Intervention with difficult logistics
	Payer influence/ lack of reimbursement
	Lack of incentive to change
	Limited availability of resources/ organizational support