BMJ 1998;317:1130-1134 ( 24 October )

General Practice

From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia

Editorial by Fahey and pp   1120 , 1125 , 1134

Karen Fairhurst, lecturer,  Guro Huby, research associate. 

Department of Community Health Sciences (General Practice), University of Edinburgh, Levinson House, Edinburgh EH8 9DX

Correspondence to: Dr Fairhurst Karen.Fairhurst{at}ed.ac.uk

Objectives To explore how general practitioners have accessed and evaluated evidence from trials on the use of statin lipid lowering drugs and incorporated this evidence into their practice. To draw out the practical implications of this study for strategies to integrate clinical evidence into general medical practice.
Design Qualitative analysis of semistructured interviews.
Setting General practices in Lothian.
Subjects 24 general practitioners selected to obtain a heterogeneous sample.
Results Respondents were generally aware of the evidence relating to the use of statins in secondary prevention of coronary heart disease, but they were less clear about the evidence in primary prevention. The benefits of statins in secondary prevention were clearer to them and the social and economic issues less complex than was the case for use in primary prevention. Respondents rarely said they appraised the methods and content of trials, rather they judged the trustworthiness of the source of trial evidence and interpreted it within the context of the economic and social factors which impinge on their practice. Moreover, trial data become relevant for routine practice only when underpinned by a consensus on these issues.
Conclusion Strategies to promote incorporation of evidence from clinical trials into everyday practice are likely to be effective if they tap into and build on the process of local consensus building. Strategies such as teaching critical appraisal skills and guideline development may have little effect if they are separated from this process.

Key messages

  • Use of clinical trial evidence to underpin everyday practice is seen as a key component of a cost effective high quality health service

  • Strategies to facilitate use of clinical evidence in practice---for example, appraisal and clinical guidelines---may fail if they are based on unrealistic models of how evidence is assessed

  • In this study the general practitioners interviewed rarely critically appraised trial data but evaluated trial evidence in terms of its social and economic implications

  • Local consensus about trial findings and their implications strongly influenced incorporation of trial evidence into everyday practice

  • Strategies to maximise the use of clinical evidence in practice should build on local consensus



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