A qualitative examination of primary care providers' and physician managers' uses and views of research evidence

Objectives. To examine the reasons and search strategies related to physicians' search for evidence and to compare clinician and physician manager approaches. Design. Qualitative analysis of verbatim transcripts of four focus groups in 2002. Study setting. Clinicians and managers in community practices in Southern California. Participants. Pediatricians, family practitioners, and general internists (i.e. child and adult primary care providers) in nonacademic practice and physician managers whose primary responsibility involved making management decisions within a moderate to large sized health care delivery system (e.g. health plan, community hospital, large group practice). Main outcome measures. Themes related to clinician and manager reasons for using evidence and approach to selecting among evidence sources. Results. Clinicians and managers differed substantially in their reasons for using evidence. Whereas clinicians consistently invoked clinical intuition as a guide to most routine clinical decisions, managers articulated both motivation and interest in using medical research to guide decision-making, most commonly prompted by cost. Both clinicians and managers rated trustworthiness as a paramount consideration in arbitrating between evidence sources, because neither group evinced comfort with the complexity of primary literature. Both groups expressed a preference for tested, convenient, and respected evidence sources such as expert colleagues and professional societies. Conclusions. Because clinicians invoke intuition in confronting the challenges of daily practice, evidence-based medicine interventions that target managers are likely to have larger effects on health outcomes than those that target primary care providers and individual patient treatment. Ensuring trustworthiness of evidence is of the utmost importance. Because both groups express discomfort with the format of primary evidence sources, strategies should probably not rely on individual appraisal.