Clinical guidelines: attitudes, information processes and culture in English primary care

The application to clinical medicine of evidence-based clinical guidelines is an increasingly international policy prescription, yet research on how s uch guidelines might be implemented has tended to focus on change initiativ es without seeking to understand change processes. This paper reports an em pirical study of guideline implementation in UK general practice. Most GPs welcome guidelines as a means of improving care, though have reservations a bout their authority, relevance and effect on professional autonomy. 'Clan' organizational culture predominates and general practices do not generally have well - functioning internal arrangements for the management of clinic al evidence and related information. We found no coherent relationships bet ween these variables and practices' actual uptake of guidelines. Copyright (C) 2001 John Wiley & Sons, Ltd.