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I wrote a grant for a novel concept of 'EBM consult team' (just like cardiology or nephrology consult team) for a University Hospital Internal Medicine program. Unfortunately the money that was being granted was insuffiicient for this very exciting and a novel idea and hence the project did not go through. However, we did design the study in the following divisions: 1. Patient characteristics affecting the use of evidence based medicine ( e.g. 1. patient not being treated with ACE inhibitors for hypertension and coronary artery disease ina diabetic is his or her intolerance in form of cough or other side effects 2. Patient prefering to buy a less expensive medication than a better pharmacologic alternative 3. Patients percieved intolerance (not real intolerance) ... so on and forth). 2. Physician characteristics ( for example use of a proven ACE agent over a new agent that has not been studied adequately, use of ARB instead of ACE, influence of his prevous anecdotal experiences (Mr. X. reacted so badly to this ACE agent that I will never use it again !!!, institution where he trained, peer influence, sales rep influence, inadequte time to look up the literature, laziness (yet to look up).... so on and so forth. 3. Literature characteristics ( is literature unabiguous about the risk and benefit of a particular intervention ?, is literature readily accesible (english/non english), is statistics simple enough for an average busy practitioner to understand ?) 4. Environmental characteristics: Formulary or non formulary in the hospital, cost containment, availability of access to evidence based medicine data, computers, library suport... etc. I am glad you are doing this study. But the "TRUTH of TRUTH" remains as follows: 1. Can we unabiguosly prove practicing EBM improves patient satisfaction ? In real world that is what counts-- patient satisfaction (e.g. steroid use by practitioners to make patient feel better quicker, eventhough the therapy may not be evidence based) 2. Does practicing EBM provide better reimbusement to the practicing physicians ? Reimbursement is the bottom line for the physicians. 3. Is a physician willing to take time to look up the evidence instead of stock quotes or instead of seeing few extra patients to bring in more income ? 4. Is a physician willing to sacrifice the brainwashing by the sales representative (sales rep), nice luches at exotic restaurants, trips to exotic places, reimursements as 'consultants' for the specifiic products ? I do believe there is a 'real world' practice of Medicine and there is 'ivory tower' practice of medicine. Physicians reimbursements and incentives in general and in a small part patient satisfaction drives the practice of medicine--evidence based or non evidence based. I hope this helps. Sachin Dave, MD. Indianapolis, IN. Takeo Saio <[log in to unmask]> wrote: Hello, EBMers! As I'm one of co-planner of the study Dr. Nomura mentioned below, I'll add a bit explanation to his question; about backgroundof his question. In Japan, the term "Evidence-based Medicine" has getting popular and popular to medical workers these days. But seemingly, and better than worse but no good, to know the term EBM does NOT mean to practice evidence-based manner. ONLY little number of medical workers attmpt to practice EBM in Japan but turned to fail to do that. The reason of the failure is considered that we Japanese have scarcely proficient either in English , statistics and computer literacy but no evidence about that is established yet. We are confident that to clarify the obstacles of evidence-based practice in Japan would succeed to break them. So we are planning to perform Japanese medical workers a medico-sociological or knowledge scientific study. We really appreciate somebody show us any possible ideas to accomplish our aim of study . Regards Saio ----- Original Message ----- From: "Hideki Nomura" To: Sent: Thursday, February 01, 2001 12:34 PM Subject: Barriers to accept and perform EBM in clinical settings > Dear List Members: > > > My colleagues and I are planning a qualitative research to identify > barriers to accept the concept of and to follow the guidance of > Evidence-Based Medicine in clinical settings in our country. I would > appreciate any information which may help us designing this study, > especially of similar studies conducted in other nations. > > > Hideki Nomura, M.D., Ph.D. > Deputy Director/Associate Professor > Department of General Medicine > Kanazawa University Hospital > Kanazawa 920-8641, JAPAN > ******************************************************** SAIO, Takeo MD. e-mail; [log in to unmask] //////////****Atami Millennial Hospital, Japan****///////////// 17-1, Izumi, Atami, 413-0001, Japan Tel; +81-465-63-5881 FAX; +81-465-63-6061 ////////////////////***********///////////////////////// "It is a fundamental right that when any one gets ill, they must have access to safe and effective treatment" ********************************************************* --------------------------------- Do You Yahoo!? Yahoo! Auctions - Buy the things you want at great prices.