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Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods.
Journal of the Medical Library Association ( IF 2.323 ) Pub Date : 2020-07-01 , DOI: 10.5195/jmla.2020.787
Marianne D Burke 1 , Liliane B Savard 2 , Alan S Rubin 3 , Benjamin Littenberg 4
Affiliation  

Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider's perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial. Methods: Using a convergent mixed methods design, the authors had PCPs complete a post-trial survey and participate in interviews about using the CET for managing patients' skin problems. Data from both methods were integrated. Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact. Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management.

中文翻译:

在初级保健中使用临床证据技术管理皮肤问题的障碍和促进因素:来自混合方法的见解。

目的:很少有研究从提供者的角度检查单一临床证据技术 (CET) 对提供者实践或患者结果的影响。之前的一项使用患者报告数据的集群随机对照试验测试了 CET(即 VisualDx)在改善皮肤问题结果方面的有效性,但没有发现显着效果。这项后续研究的目的是从初级保健提供者 (PCP) 的角度确定使用 CET 的障碍和促进因素,并确定 CET 不影响试验结果的原因。方法:作者使用收敛的混合方法设计,让 PCP 完成一项试验后调查,并参与有关使用 CET 管理患者皮肤问题的访谈。两种方法的数据被整合。结果:PCP 发现 CET 有点容易使用,但只是偶尔有用。经验较少的 PCP 更频繁地使用 CET。访谈数据揭示了循证实践四个步骤的障碍和促进因素:临床问题识别、信息获取、相关性评估以及与患者的应用。促进因素包括皮肤病学的不确定性、使用意图、访问便利性、诊断和治疗支持以及患者沟通。障碍包括对皮肤病学的信心、对其他来源的偏好、界面困难、不相关信息的存在以及缺乏决策影响。结论:PCP 发现 CET 可用于诊断、治疗支持和患者沟通。但是,界面困难,搜索结果不相关的障碍,
更新日期:2020-07-01
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