Is the practice of public or private sector doctors more evidence-based? A qualitative study from Vellore, India. Issue 2 (June 2015)

• Record Type: Journal Article
• Authors: Akinyemi, Oluwaseun O.; Martineau, Tim; Tharyan, Prathap
• Is Part Of: International journal of evidence-based healthcare. Volume 13:Issue 2(2015:Jun.)
• Publication Date: 2015-06
• Subjects: evidence-based practice -- government practitioners -- India -- private practitioners -- qualitative research; Nursing -- Periodicals; Midwifery -- Periodicals; Evidence-based medicine -- Periodicals; 616.005
• DOI: 10.1097/XEB.0000000000000042
• Languages: English
• ISSNs: 1744-1595

Abstract

ABSTRACT: Aim: The literature on the use of evidence-based practice is sparse, both in the public and private sectors in middle-and low-income countries, and the present literature shows that physician understanding and use of evidence-based practice is poor. The study aimed to explore the perception of medical practitioners in the private for-profit, private not-for-profit and government sectors in Vellore, India, on evidence-based practice, in order to explain the factors affecting the use of evidence-based practice among the practitioners and to inform local policy and management decisions for improvement in quality of care. Methods: Qualitative methodology was employed in the study. Sixteen in-depth and two key informant interviews were carried out with medical practitioners selected by purposive sampling in the private for-profit, private not-for-profit and government sectors. The interviews explored participants' knowledge of evidence-based practice, factors affecting its use and possible ways of improving the use of evidence-based practice among physicians in all the health sectors. Data from the in-depth and key informant interviews were analyzed with the NVIVO (version 8) software package using the framework approach. Results: Although most practitioners interviewed have heard of evidence-based practice, knowledge about evidence-based practice seems inadequate. However, doctors in the private not-for-profit sector seem to be more familiar with the concept of evidence-based practice. Also, practitioners in the private not-for profit sector appear to use medical evidence more in their practices compared to government practitioners or doctors in the private for-profit sector. Perceived factors affecting physician use of evidence-based practice include lack of personal time for literature appraisal as a result of high case load, weak regulatory system, pressure from patients, caregivers and pharmaceutical companies, as well as financial considerations. Opinions of the respondents are that use of evidence-based practice is mostly found among practitioners in the private not-for-profit health sector. Conclusion: Better training in evidence-based practice, improved regulatory system and greater collaboration between the public, private for-profit and private not-for-profit sectors with regards to training in evidence-based practice – literature search and critical appraisal skills – were suggested as needed to improve the present situation.