Barriers to evidence-based medicine: a systematic review

J Eval Clin Pract. 2014 Dec;20(6):793-802. doi: 10.1111/jep.12222. Epub 2014 Aug 18.


Introduction: Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM.

Methods: Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID.

Results: Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines.

Conclusion: The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled.

Keywords: barrier; content analysis; evidence-based medicine; guideline; research utilization; systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Clinical Competence
  • Communication Barriers
  • Delivery of Health Care / organization & administration
  • Evidence-Based Medicine / organization & administration*
  • Female
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians' / organization & administration*
  • Quality Assurance, Health Care / organization & administration*