To which extent clinical practice is guided from evidence based medicine principles? results of a systematic review of surveys on Italian physicians

Background Ensuring the uniform delivery of high-quality level of care across European countries requires integration of knowledge from Evidence Based Medicine (EBM). Using the best knowledge to identify what to do and how to make it part of routine practice in an effective and cost-effective way appears obvious, but this integration of content and context seldom happens. This systematic review summarizes the results of cross-sectional surveys carried out among Italian physicians to analyze their knowledge and professional behaviors towards health interventions and EBM. Methods Surveys evaluating knowledge, attitudes, behaviors and training needs of Italian physicians towards any type of therapeutic or preventive intervention and EBM were initially searched in Pubmed (to March 2014) without language restriction. Additional searches in EMBASE were carried out and bibliographies of relevant articles were systematically reviewed. Results A total of 192 studies were retrieved. Of these, 37 surveys matched our inclusion criteria. Most of the surveys were focused on physicians’ training needs (21 surveys; 56.8%), 6 surveys (16.2%) regarded physicians’ use of effectiveness and cost-effectiveness evaluation, while 5(13.5%) and 6(16.2%), respectively, faced specific arguments on physicians’ behavior towards therapies and preventive interventions. Despite satisfactory knowledge and substantial positive attitudes, Italian physicians’ behaviors appear not to be completely guided by EBM principles. The results of two surveys show that an appropriate professional use of EBM is higher with a previous exposure to EBM during graduate/post-graduate training (OR 2.25, 95% CI 1.44-3.52), and that adequate knowledge and positive attitudes towards cost-effectiveness principles are associated with previous training experience about health economics and management. Nevertheless, Italian physicians demonstrate a high level of interest in further training. Conclusions More pre and post-graduate educational interventions are needed to bring both components—effectiveness and costeffectiveness—together to provide better patient care. This integrated evidence-based approach can reduce the quality gap and instill greater confidence in the Italian health care system. Key messages The introduction of EBM principles in clinical practice has not been totally completed. More educational interventions are needed to improve physicians’ use of EBM.