Barriers and bridges to evidence based clinical practice

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Brian Haynes (bhaynes@fhs.mcmaster.ca), professor of clinical epidemiology and medicinea,
Andrew Haines, professor of primary health careb

^aFaculty of Health Sciences, McMaster University, 1200 Main St West, Hamilton, Ontario, Canada L8N 3Z5
^bDepartment of Primary Care and Population Sciences, Royal Free and University College London Schools of Medicine, London NW3 2PF

Correspondence to: Professor Haynes

This is the fourth in a series of eight articles analysing the gap between research and practice

Series editors: Andrew Haines and Anna Donald

Clinicians and healthcare planners who want to improve the quality and efficiency of healthcare services will find help in research evidence. This evidence is increasingly accessible through information services that combine high quality evidence with information technology. However, there are several barriers to the successful application of research evidence to health care. We discuss both the prospects for harnessing evidence to improve health care and the problems that readers—clinicians, planners, and patients—will need to overcome to enjoy the benefits of research(box).

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Problems in implementing evidence based medicine and possible solutions

The aim of evidence based health care is to provide the means by which current best evidence from research can be judiciously and conscientiously applied in the prevention, detection, and care of health disorders.1 This aim is decidedly ambitious given how slowly important new treatments are disseminated into practice^2–%4and how resistant practitioners are to withdrawing established treatments from practice even once their utility has been disproved.5

Summary points

The aim of evidence based practice is to integrate current best evidence from research with clinical policy and practice
Practitioners have difficulty finding, assessing, interpreting, and applying current best evidence
New evidence based services (such as electronic databases, systematic reviews, and journals that summarise evidence) make accessing current best evidence feasible and easy in clinical settings
Progress is slow in creating evidence based clinical policy and in ensuring that evidence and policy are applied at the right time

The barriers to the dissemination and timely application of research findings in the making of decisions about health care are complex and have been little studied. They include many factors beyond the control of the practitioner …