Barriers to EBP with strategies

Barrier

Description

Strategies to overcome

Time

The practitioner may not have time to search and appraise the evidence relevant to each clinical question.

• Journal clubs at the practice, or among a group of practices.
• Anticipation of “FAQ” clinical questions that can go through the first three EBP steps so that when the patient presents recent best evidence is available.
• Use of online open access systems to obtain level 1 evidence quickly.
• Use of online systems to access databases with ready-appraised evidence.

Access to evidence

The practitioner is unlikely to have access to all peer-reviewed publications in which external research reports can be found.

• Practitioner awareness of all available open-access sources of relevant evidence.
• Potentially, professional body providing an optometry-specific database with ready-appraised evidence (e.g. “SightBite”).

Communication

The practitioner might not explain their advice clearly, or the patient may not understand it. This may be due to a language barrier or simply poor explanation of the need for an evidence-based strategy.

• Language barriers overcome by translator as needed.
• Practitioner training for good communication of evidence-based strategies and the importance of these.

Skills and knowledge

The practitioner may not have the skills required for EBP. He/she may not know what EBP means, or may be unable to ask a focused clinical question, search for and appraise evidence, and apply the answer to that question.

• Optometrist training in EBP skills and knowledge at undergraduate level.
• Professional requirement for maintenance via continuing education.
• Professional requirement for continuing education to teach and assess these skills and knowledge.

Practice environment

The practice may facilitate or inhibit the application of EBP, in any one of several ways. For example, the practice may or may not provide computers with Internet access. The culture of the practice may or may not encourage EBP. In a teaching practice, the teachers may or may not encourage questions and challenges from students.

• In educational practice environments, professional body requirement for trainees to challenge their teachers and to support their own arguments with appropriate evidence.
• Professional body requirement for EBP encourages EBP centrally, with an influence on individual practices.

Patient’s attitude

The patient may not follow the optometrist’s evidence-based advice if it conflicts with advice received elsewhere (e.g. from another eye-care practitioner). This may be exacerbated if there are cultural or other differences that deter the patient from heeding the optometrist’s advice.

• Explain the basis for the advice as clearly as possible.

Patient’s preferences

The patient may not want what the practitioner is advising. The practitioner may not have taken the patient’s preferences into account before applying EBP, or it may be that the advice needs to be given (e.g. adherence to glaucoma treatment) despite the patient’s preference.

• Take into account patient’s preferences when applying EBP.
• If important advice conflicts with patient’s preference (e.g. a child with amblyopia does not wish to be occluded) discuss a compromise intervention that will be effective (based on best evidence) and will not discourage compliance.