OBSTACLES TO IMPLEMENTING EVIDENCE-BASED PRACTICE IN BELGIUM: A CONTEXT-SPECIFIC QUALITATIVE EVIDENCE SYNTHESIS INCLUDING FINDINGS FROM DIFFERENT HEALTH CARE DISCIPLINES

Abstract

A number of barriers to the implementation of evidence- based practice have already been inventoried. However, little attention has been given to their contextspecific nature. This qualitative evidence synthesis examines commonalities in the obstacles perceived by different groups of health care practitioners working in the Belgian health care system and sets out to discuss potential strategies to bridge some of these barriers. We actively searched for primary studies addressing our topic of interest in international and national databases (1990 to May 2008), consulted experts and screened references of retrieved studies. We opted for the metaaggregative approach, developed by the Joanna Briggs Institute, to analyse our findings. The findings indicate that (1) evidence might have a limited role in decisionmaking processes; (2) aspects other than quality of care steer the evidence-based practice agenda; (3) some health care providers benefit less from evidence-based practice than others and (4) there is a lack of competences to put the evidence-based principles in practice. Belgian policy makers might consider health care system characteristics from and strategies developed or suggested by others to respond to country-specific obstacles. Examples include but are not limited to; (a) providing incentives for patient-centred care coordination and patient communication, (b) supporting practitioners interested in applying research-related activities, (c) considering direct access systems and interprofessional learning to respond to the demand for autonomous decision-making from satellite professional groups, (d) systematically involving allied health professionals in important governmental advisory boards, (e) considering pharmaceutical companies perceived as ‘the enemy’ an ally in filling in research gaps, (f) embedding the evaluation of evidence-based knowledge and skills in examinations (g) moving from (in)formative learning to transformative learning and (h) organizing high quality catch-up programs for those who missed out on evidence- based medicine in their curriculum.

Keywords:

• qualitative evidence synthesis
• systematic review
• evidence-based practice
• implementation