USE OF GUIDELINES IN PRIMARY-CARE - PRACTITIONERS PERSPECTIVES

Background and objectives. Concern about the inadequate take-up of gui delines in general practice has concentrated on problems arising from the process of their development and implementation. However, these pe rspectives fail to take account of the needs, attitudes and problems o f GPs themselves. In this study we aimed to identify barriers to the u se of guidelines and opportunities for tackling them, from the point o f view of the GP, so that future guideline development and policy coul d be more sensitive to the needs of GPs in the environment in which th ey work. Method. Twenty in-depth semi-structured interviews were audio taped with GPs from within the Avon Health Authority area, representin g GPs with different backgrounds and working environments. The transcr ibed data collected were analysed using a grounded theory approach. Re sults. Utilization of guideline information is complex. GPs' appraisal s 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 mo st likely to be referred to may be those either very rarely or very co mmonly presenting in general practice. Key issues for the uptake of gu idelines in the consultation are: general preference for certain forma ts of presentation; reputability and ownership; use of guidelines in s hared decision-making; scope for computer-based systems; and GPs attit udes 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 sys tems customized for individual GPs or practices. Novel means of stimul ating 'ownership' and demonstrating reputability should be sought. The analysis provides a framework for understanding the complexities of t he processes of GPs' use of guidelines in practice which can be useful in explaining the results of trials of guideline effectiveness. Guide line implementation occurs in the context of conflicting pressures for clinical autonomy and professional standardization and quality improv ement.