Evidence-based practice in well-child care

Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one's own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time. Conclusions: Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems.

Automated summary

Dutch community pediatricians mainly rely on professional guidelines in their daily practice and rarely perform evidence-based practice searches. For psychosocial problems, they prefer extensive interaction with clients and multidisciplinary teams. Barriers to performing evidence-based practice searches include a lack of awareness that not every pediatrician needs to do them, a belief that they are not suitable for psychosocial problems, a lack of confidence, limited access to literature, and a lack of time.