Why do GPs not implement evidence-based guidelines? A descriptive study

Background. There is an acknowledged gap between research findings and thei r implementation in clinical practice despite the existence of effective ed ucational interventions. Objectives. Our aim was to identify what is impeding GPs from pursuing curr ently recognized good practice and implementing evidence-based guidelines i n their management of hypertension in the elderly. Method. We carried out a qualitative study using semi-structured interviews conducted during focus group outreach visits to 34 GPs from nine practices in Merseyside involved in an educational programme designed to improve the management of hypertension in the elderly. Results. Several barriers to the implementation of evidence-based guideline s in the management of hypertension in the elderly were identified. These i ncluded: doubts about the applicability of trial data to particular patient s; the poor adherence of GPs to practice protocols; ageist attitudes of som e GPs; the effect of time pressure and financial considerations making the subject a low priority; the absence of an effective computer system; and th e absence of an educational mentor. All participants demonstrated a very po sitive attitude to practice-based education. They also welcomed external au dit data, which compared their performance with that of other practices. Si ngle-handed GPs were particularly enthusiastic about this approach as it pr ovided them with the peer pressure they lacked. Conclusions. In order to bridge the gap between research and practice, educ ators need to address the various 'barriers to change' amongst practitioner s.