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, PCPs completed a post-trial survey and participated in interviews about using the CET for the management of 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.


Data Availability Statement: Data supporting the findings of this study are openly available in figshare at http://10.6084/m9.figshare.11893875.v3 (survey data) and http://10.6084/m9.figshare.11893956.v1 (qualitative data).


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; Technology Assessment; Mixed Methods

Document Type


Publication Date


Creative Commons License

Creative Commons Attribution-Share Alike 4.0 International License
This work is licensed under a Creative Commons Attribution-Share Alike 4.0 International License.



Supplem. File 1 Burke et al 12_8_2019.pdf (69 kB)
Survey of Primary Care Providers Post-CRCT

Supplem file 2 Burke et al 12_8_2019.pdf (56 kB)
Semi-structured Interviews Outline

Link to Article at Publisher Website