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Development and pilot testing of a tool to assess evidence-based practice skills among French general practitioners.

ABSTRACT: BACKGROUND:There is currently an absence of valid and relevant instruments to evaluate how Evidence-based Practice (EBP) training improves, beyond knowledge, physicians' skills. Our aim was to develop and test a tool to assess physicians' EBP skills. METHODS:The tool we developed includes four parts to assess the necessary skills for applying EBP steps: clinical question formulation; literature search; critical appraisal of literature; synthesis and decision making. We evaluated content and face validity, then tested applicability of the tool and whether external observers could reliably use it to assess acquired skills. We estimated Kappa coefficients to measure concordance between raters. RESULTS:Twelve general practice (GP) residents and eleven GP teachers from the University of Bordeaux, France, were asked to: formulate four clinical questions (diagnostic, prognosis, treatment, and aetiology) from a proposed clinical vignette, find articles or guidelines to answer four relevant provided questions, analyse an original article answering one of these questions, synthesize knowledge from provided synopses, and decide about the four clinical questions. Concordance between two external raters was excellent for their assessment of participants' appraisal of the significance of article results (K?=?0.83), and good for assessment of the formulation of a diagnostic question (K?=?0.76), PubMed/Medline (K?=?0.71) or guideline (K?=?0.67) search, and of appraisal of methodological validity of articles (K?=?0.68). CONCLUSIONS:Our tool allows an in-depth analysis of EBP skills, thus could supplement existing instruments focused on knowledge or specific EBP step. The actual usefulness of such tools to improve care and population health remains to be evaluated.

SUBMITTER: Rousselot N

PROVIDER: S-EPMC6234795 | biostudies-other | 2018 Nov

REPOSITORIES: biostudies-other

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Development and pilot testing of a tool to assess evidence-based practice skills among French general practitioners.

Rousselot Nicolas N Tombrey Thomas T Zongo Drissa D Mouillet Evelyne E Joseph Jean-Philippe JP Gay Bernard B Salmi Louis Rachid LR

BMC medical education 20181109 1

<h4>Background</h4>There is currently an absence of valid and relevant instruments to evaluate how Evidence-based Practice (EBP) training improves, beyond knowledge, physicians' skills. Our aim was to develop and test a tool to assess physicians' EBP skills.<h4>Methods</h4>The tool we developed includes four parts to assess the necessary skills for applying EBP steps: clinical question formulation; literature search; critical appraisal of literature; synthesis and decision making. We evaluated c ...[more]

PMID: 30413196

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Project description:ObjectiveThere has been an increase in testing of vitamins in patients in general practice, often based on irrational indications or for non-specific symptoms, causing increasing healthcare expenditures and medicalisation of patients. So far, there is little evidence of effective strategies to reduce this overtesting in general practice. Therefore, the aim of this qualitative study was to explore the barriers and facilitators for reducing the number of (unnecessary) vitamin D and B12 laboratory tests ordered.Design and settingThis qualitative study, based on a grounded theory design, used semistructured interviews among general practitioners (GPs) and patients from two primary care networks (147 GPs, 195?000 patients). These networks participated in the Reducing Vitamin Testing in Primary Care Practice (REVERT) study, a clustered randomized trial comparing two de-implementation strategies to reduce test ordering in primary care in the Netherlands.ParticipantsTwenty-one GPs, with a maximum of 1 GP per practice who took part in the REVERT study, and 22 patients (who were invited by their GP during vitamin-related consultations) were recruited, from which 20 GPs and 19 patients agreed to participate in this study.ResultsThe most important factor hampering vitamin-test reduction programmes is the mismatch between patients and medical professionals regarding the presumed appropriate indications for testing for vitamin D and B12. In contrast, the most important facilitator for vitamin-test reduction may be updating GPs' knowledge about test indications and their awareness of their own testing behaviour.ConclusionTo achieve a sustainable reduction in vitamin testing, guidelines with clear and uniform recommendations on evidence-based indications for vitamin testing, combined with regular (individual) feedback on test-ordering behaviour, are needed. Moreover, the general public needs access to clear and reliable information on vitamin testing. Further research is required to measure the effect of these strategies on the number of vitamin test requests.Trial registration numberWAG/mb/16/039555.

Project description:We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9-5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15-3.16), working in a suburban area (5.23, 2.18-12.58), and having more than 28 appointments per day (1.95, 1.19-3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93-2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02-1.67 and 1.86, 1.34-2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51-0.83; 0.66, 0.48-0.92; and 0.42, 95%CI 0.23-0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13-0.47), as did group practice for intermediate level of burnout (0.71, 0.51-0.96). GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.

Dataset Information

Development and pilot testing of a tool to assess evidence-based practice skills among French general practitioners.

Publications

Development and pilot testing of a tool to assess evidence-based practice skills among French general practitioners.

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