A comparison of the perceptions, use and barriers to evidence based practice by chiropractors and general practitioners in the eThekwini municipality

Abstract

Background: Medicine was the first profession to embrace evidence-based practice (EBP) and has subsequently been the leading profession with its implementation. Many other healthcare professions, including chiropractic, have since embraced the EBP movement. Despite this acceptance, many practitioners report difficulty implementing it into practice. This study aimed to compare the perceptions, use and barriers to EBP by chiropractors and general practitioners (GPs) in private practice within the eThekwini municipality.

Method: The study utilised a quantitative paradigm and a cross-sectional descriptive survey design. Once the Durban University of Technology (DUT) Institutional Research Ethics Committee (IREC) approval was obtained, chiropractors (n = 101) and GPs (n = 289) in private practice within the eThekwini municipality were invited to participate. A pre- validated questionnaire and letter of information and consent were administered by electronic mail or hand delivery. The data was analysed using SPSS Version 24.0, (IBM, Armonk NY, U.S.A.) and Statgraphics Centurion (Statgraphics Technologies Inc, Warrenton, Virginia, U.S.A.). A p-value <0.05 was considered as statistically significant. Descriptive and inferential statistics such as cross-tabulations, chi-squared and fisher‘s exact tests were utilised.

Results: A 50.5% (n = 51) response rate from the chiropractor respondents and 50.9% (n = 147) with regards to the GP respondents was achieved with respondents having an overall positive perception of EBP, its necessity, use and benefit in patient care. The respondents also displayed a willingness to adopt and improve their use of and skills in EBP. The GP respondents‘ perceptions were more favourable towards the necessity of the application of EBP and the use of literature and research findings in daily practice when compared to those of the chiropractic respondents.

The majority of respondents from both professions reported to read and use scientific literature and databases on a regular basis. Most of the GP respondents read scientific

literature two to five times per week, while less than half of the chiropractic respondents reported to do the same.

The greatest barrier to the use of EBP reported by both professions was insufficient time with significantly more GPs than chiropractors reporting it as their top barrier. Inability of the professional to generalise literature findings to their patient population and inability of the professional to apply research findings to individual patients with unique characteristics were the next main barriers experienced by both professions. Significantly more chiropractic than GP respondents ranked their inability to apply research findings to individual patients with unique characteristics as their top barrier to EBP. Lastly, significantly more chiropractic than GP respondents ranked a lack of collective support among their colleagues in their facility as their greatest barrier to EBP.

Conclusion and Recommendations:

Both professions were found to have a positive perception of EBP and to be utilising scientific literature and databases regularly. A lack of time was the greatest barrier to the use of EBP, a finding similar to studies conducted with other healthcare professionals. Mechanisms need to be developed to aid practitioners to make time for EBP.