Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods


  • Marianne D. Burke Associate Professor of Libraries, Emerita, Dana Medical Library, University of Vermont, Burlington, VT
  • Liliane B. Savard Associate Faculty, Rehabilitation and Movement Science, Clinical and Translational Science, University of Vermont, Burlington, VT
  • Alan S. Rubin Associate Professor, Department of Medicine, University of Vermont, Burlington, VT
  • Benjamin Littenberg Professor of Medicine, General Internal Medicine Research, Larner College of Medicine, University of Vermont, University of Vermont Medical Center, Burlington, VT



Evidence-Based Medicine, Evidence-Based Practice, Decision-Support Systems, Medical Informatics Applications, Libraries, Hospital, Information Storage and Retrieval, Databases, Factual, Information-Seeking Behavior, Skin Diseases, Primary Health Care, Tec


Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial.

Methods: Using a convergent mixed methods design, the authors had PCPs complete a post-trial survey and participate in interviews about using the CET for managing patients’ skin problems. Data from both methods were integrated.

Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact.

Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management.


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Original Investigation