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However, despite the findings of Pound et al, 21 doctors in our study infrequently mentioned patients' use of their medications outside the consultations.
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From " outside" the consultation one of the conditional factors for using the EBM and CPGs was their linkage to economic efficiency and control promoted by management.
On the other hand, however, and often more importantly, EBM was considered a " reactive" resource related to interests and pressures from " outside" the consultation, and even from "outside" the real patients' needs.
The second, necessarily related to the first, tried to show the diverse paths from " outside" the consultation room, that is, beyond the relationship with the patient, that especially condition the use of EBM in PC.
Most patient decision aids are designed so that patients can work through them on their own (at home or somewhere else outside of the consultation): for that reason, they can generally be described as patient-mediated interventions.
But the plan quickly fell victim to criticism from those outside the consultation process and to political infighting within it.
So we need to find new solutions for 24-hour monitoring services and new ways to answer patient questions outside the consultation, especially for the chronically ill.
Few doctors discussed methods to support patients to use drug treatments outside the consultation.
The lack of consideration of what goes on outside the consultation is particularly interesting and worrying.
This does not mean that these patients are not autonomous people outside the consultation room.
Implementation is also conditioned by what we denominated a "defensive reaction" whose origins were found mainly "outside" the consultation.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com