Evidence-based Medicine Practise among Doctors Working at Specialized Referral Hospitals in Amhara Region, 2020

Abstract

Abstract Background: The practice of evidence-based medicine of doctors is important to improve the quality of healthcare provided at the point of care. Doctors‘ clinical practise should be based on recent evidence and without it their practise will not be updated resulting harm to patients. Further, evidence-based medicine (EBM) practise is not widely implemented in primary care by doctors working in low income countries like Ethiopia. This study is therefore aimed to examine the level of EBM practice and identify associated factors among doctors working in Amhara Region, Ethiopia. Objective: The objective of this study is to determine the level of evidence-based medical practise and associated factors among doctors working at specialized referral hospitals in Amhara Region. Methods: An institution-based cross-sectional quantitative study was conducted from September 1 to September 30, 2020 on doctors working at university-based hospitals and hospitals where residents are practising (Tibebe Ghion Hospital, University of Gondar College of Medicine and Health Science and Felege Hiwot Referral Hospital) in Amhara Region. Based on the assumption of single population proportion formula a total of 423 study subjects selected and stratified simple random sampling with proportional allocation was used to select the study participants. Data was collected using a pretested self-administered questionnaire. Data were coded and entered to EpiData version 4.6.0.2 then exported to and analysed by using IBM SPSS Version 22. Three 3-point Likert scale and 4 dichotomized scale items were used to measure the level of EBM practise and median was computed and used to classify the participants into two groups: as those having good and poor EBM practise. Bivariate logistic regression was done on the predictor variables to see their effect on the EBM practise. Multivariable logistic regression analysis was done and the significantly associated factors (p-value of less than or equal to 0.05) with the EBM practise were identified holding the effect of the other variables constant. Results: Response rate was 95.7%. Among the study participants, only 55.7% had good EBM practise. Doctors who were using EBM guidelines and Medline/PubMed for making evidence-based clinical decision were 2.289 and 2.945 times more likely to have good level of EBM practise respectively. Further, 93.8% of the participants thought that EBM practise improves patient outcomes and 95.3% thought that medical decisions should be based on reliable statistical information on risks and benefits. UpToDate (97.8%),

PubMed/Medline (81%), EBM guidelines (56.3%) and Critically Appraised Topics (CATs) (28%) were the electronic database resources that were mostly used by the doctors for making EBM practise. Further, smartphones were all the time used by 69.8% of the doctors to access health information. Conclusion: The number of doctors having good EBM practise in this study is suboptimal. Attending EBM training, taking part in an on-going research, doctors‘ thought on EBM based on patient preference were the positively associated factors with their EBM practise. Stakeholders‘ involvement in providing trainings and increasing doctors‘ access of electronic information sources will further enhance their EBM practise. Key words: Attitude towards EBM, Doctors, Evidence-based medicine, Evidence-based medical practise, Residents, Understanding of EBM terms