Article
What are family physicians' perceptions of guideline implementation and uptake? A qualitative study
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Published: | July 10, 2012 |
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Outline
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Background: Guidelines are not consistently implemented and can be confusing and difficult to use.
Objectives: As guideline characteristics are best assessed by end-users, the current study explored how family physicians perceive guideline implementability, and which attributes may comprise an implementability tool.
Methods: We conducted a qualitative study of interviews with community and academic family physicians, selected from a Canadian physician society database and a targeted family practice at St. Michael’s Hospital in Toronto. Two investigators conducted the interviews using semi-structured, open-ended questions to reveal facilitators and barriers to guideline use, to obtain feedback on draft guideline recommendations, and to suggest ideas to build a tool to enhance guideline implementability. Sessions were audio taped, and transcribed data were analyzed independently by 3 sets of investigators using grounded theory methodology.
Results: Twenty family physicians were interviewed. Informants preferred recommendations that are quickly accessible, concise, and have clear statements on diagnosis and management (e.g., clear decision tree); and formats that replicate their own clinical decision-making. Tool suggestions included a process to facilitate end-user involvement in the guideline development process, and to provide on-line resources and continuing medical education credits as incentives to encourage participation.
Discussion: Attributes described by participants were consistent with 3 of the 5 implementability dimensions found in our realist review investigating guideline implementability: language, format, and evidence.
Implications for guideline developers/users: This study represents a novel contribution to guideline implementability, as it provides empirical support for an implementability framework derived from a realist review.