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Background: There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM)The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice., Methods: Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables., Results: Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care., Conclusion: Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

Objectives: Effective knowledge translation in medicine is an essential element of a modern health care system. Evidence-based clinical practice guidelines (CPGs) are considered relevant instruments for the transfer of knowledge into clinical practice. To improve this transfer we have created Internet-based continuing medical education (CME) modules and online case-based learning objects., Methods: Building upon existing CPGs, an e-learning platform including a multi-step review process was developed to generate CME modules. These CME modules were presented through a modified content management system (CMS) that fulfils specific requirements of CME. An online questionnaire using a four-point Likert scale was designed to receive mandatory feedback from participating physicians. In the second step of development, case-based learning objects were added to the CMS., Results: Existing clinical practice guidelines allowed a rapid development of CME modules specific to individual clinical indications. The modified CMS proved to be technically stable but also resource-intensive. 3105 physicians registered and used the platform between June 2003 and April 2005. 95% of the physicians expressed positive feedback in an evaluation questionnaire; only 35% of physicians actually used the corresponding CPGs in practice. Suggestions from the CME users led to the development of interactive medical case-based learning objects related to the main topics of the CPGs., Conclusions: To support the implementation of CPGs, an Internet platform for CME including case-based learning objects and examination tests was developed. An interactive online CME platform can support active learning and may establish an additional stimulus for knowledge translation into daily medical practice.

Objectives: Shared decision making describes a way of involving patients in the planning and management of their individual healing process. Doing this effectively seems to be quite a challenge for both physicians and patients. The mutual transfer of information appears to be one of the main steps of this process. Clinical patient information or patient guidelines can help to explain complex medical processes in a non-specialist way and thus improve communication and self-management. In order to develop an "evidence-based asthma patient guideline" we tried to focus on both evidence-based recommendations and patients' perspectives. Patients were asked about their individual needs and knowledge and took part in the subsequent review., Methods: In order to explore patients' perspectives and needs we implemented two additional steps to our existing concept of guideline development: (1) a questionnaire for asthma patients with 10 items dealing with patients' knowledge about asthma and a personal grading of 16 "asthma-related questions", and (2) patients joining the actual guideline review panel., Results: By evaluating the results of the questionnaire we discovered a gap between what patients consider to be interesting and/or important and what is necessary from the point of view of medicine and health policy. Although the patients showed a great interest in an autonomous approach to life with asthma [important items: "what can I do by myself" (68%); "how can I prevent an asthma attack" (86%); "how can I live a better life with asthma" (77%)], they were less interested in topics that would give them more autonomy ["structured educational programs" (41%); "how to use inhaling devices" (64%) or "peak flow measurement" (36%)]. Patients participating in the review panel emphasized the need for more or better information about pollution (i.e. ozone), complementary/alternative methods and the administration of cortisone during the asthma attack--topics that were not mentioned in the physicians' guideline., Conclusions: To acquire an "implementable" evidence-based patient guideline it is not sufficient to "translate" existing asthma guidelines into lay language. We should focus on the needs of individual asthma patients and the problems they encounter every day. Therefore patients should be asked what they want to know and what they do not know, and they should review the results and include their own views into the guideline. We applied this concept to the above mentioned evidence-based patient guideline and received a thematic ranking focused on patients' daily needs as well as a to-do list of topics that require increased attention (like peak flow measurement and structured education programs). The patients' perspectives changed our perspective on our patient guideline more than we expected.

Acute Otitis media is one of the most common acute respiratory infections managed in primary care and the most common infection among in children. Diagnostic criteria, however, do not always correspond to scientific evidence. They often differ depending on individual preferences and competences. Treatment, also, is controversial. In Germany, most children attending their pediatrician or primary care physician will be prescribed antibiotics. Evidence from several randomized studies and systematic reviews suggests that routine usage of antibiotics provides only modest benefit. The benefit of prescribing antibiotics should not only be balanced against the increased likelihood of side effects such as diarrhoea but also against the potential to contribute to longterm antibiotic resistance.

Applying the principles of evidence-based medicine in clinical practice is becoming more and more important for healthcare professionals in Germany. In this context Witten/Herdecke University has implemented an EbM Curriculum for medical students that is closely related to problem-based learning and clinical rotations within the scope of the six-year medical reform curriculum. Starting with the first semester, students will be able to acquire the necessary skills to search medical databases, to critically review the information retrieved according to EbM standards, to gather evidence for answering diagnostic or therapeutic questions during their clinical education and to ultimately participate in the development of clinical guidelines during their last year.

The amount of medical knowledge is growing with increasing speed. Physicians are confronted with more and more--and often useless--information. However, the time lag between the creation of new knowledge and its implementation into daily medical practice is often exceeding a decade. In view of these challenges the knowledge network of the medical faculty of the University Witten/Herdecke is focusing on two different tasks: It provides evidence based medical guidelines in a format that is meant for easy access and use in daily practice. It scientifically explores different ways of presenting and transferring evidence based guidelines in order to develop better and easier ways of implementation. National and international guidelines and studies are screened, evaluated, updated and adapted for its use in the academic network by a team of five university based physicians. In addition, clinical specialists as well as primary care physicians provide expertise for detailed scientific adaptations and for adequate implementation strategies. The implementation process of the guidelines among the faculty based primary care physicians is continuously monitored and evaluated. The main goal of this concept is to create a learning environment for the complex process of medical knowledge transfer.

Background: Evidence-based guidelines are seen as an important instrument to transfer scientifically generated knowledge into daily clinical practice and to ensure high standards of clinical care. Despite wide promulgation, clinical guidelines so far have a limited impact on individual professional learning and on changing daily medical practice.Objectives: Our aims were (i) to study a potential knowledge increase among German GPs after implementation of web- and evidence-based guidelines and (ii) to identify and analyse potential barriers to individual professional learning with computerized guidelines.Methods: A prospective, randomized controlled trial was conducted including 72 GPs (21% female, 79% male). The intervention group (n = 38) had access to clinical guidelines via the Internet or CD-ROM, the control group had not (n = 34). Both groups received a standardized two-part questionnaire. An increase of knowledge was measured with 25 multiple choice questions related to four different medical topics. In addition, reasons for using or not using computerized guidelines were analysed after access to guidelines was open to all participating physicians.Results: There was no significant knowledge increase in the intervention group (P = 0.69). Twenty-two (58%) GPs of the intervention group had used the guidelines. Unspecified curiosity (76%) and a specific medical question (38%) were predominant motives for usage among physicians who had used the guidelines. Among 'non-users', 78% stated 'lack of time' as the main reason for not using guidelines.Conclusion: An efficient knowledge transfer through computerized guidelines was not achieved. Usage, individual learning and potential implementation depend on adequate incentives and pragmatic aspects of clinical practice: easy and quick access. [ABSTRACT FROM AUTHOR]