Family Practice, Vol 15, 105-111, Copyright © 1998 by World Organization of Family Doctors
C Langley, A Faulkner, C Watkins, S Gray and I Harvey
BACKGROUND AND OBJECTIVES: Concern about the inadequate take-up of
guidelines in general practice has concentrated on problems arising from
the process of their development and implementation. However, these
perspectives fail to take account of the needs, attitudes and problems of
GPs themselves. In this study we aimed to identify barriers to the use of
guidelines and opportunities for tackling them, from the point of view of
the GP, so that future guideline development and policy could be more
sensitive to the needs of GPs in the environment in which they work.
METHOD: Twenty in-depth semi-structured interviews were audiotaped with GPs
from within the Avon Health Authority area, representing GPs with different
backgrounds and working environments. The transcribed data collected were
analysed using a grounded theory approach. RESULTS: Utilization of
guideline information is complex. GPs' appraisals of the value of
guidelines interact with prior knowledge and beliefs, practicalities of
existing information storage and retrieval systems, and individual working
practices. Conditions where guidelines are most likely to be referred to
may be those either very rarely or very commonly presenting in general
practice. Key issues for the uptake of guidelines in the consultation are:
general preference for certain formats of presentation; reputability and
ownership; use of guidelines in shared decision-making; scope for
computer-based systems; and GPs' attitudes to time pressures on
information-seeking in relation to tolerance of uncertainty. CONCLUSION:
Local initiatives might usefully explore the possibilities of supporting
development of guideline-retrieval systems customized for individual GPs or
practices. Novel means of stimulating 'ownership' and demonstrating
reputability should be sought. The analysis provides a framework for
understanding the complexities of the processes of GPs' use of guidelines
in practice which can be useful in explaining the results of trials of
guideline effectiveness. Guideline implementation occurs in the context of
conflicting pressures for clinical autonomy and professional
standardization and quality improvement.
ORIGINAL CLINICAL RESEARCH
Use of guidelines in primary care--practitioners' perspectives
Department of Social Medicine, University of Bristol, UK.
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