How GPs implement clinical guidelines in everyday clinical practice--a qualitative interview study

Abstract

Background: Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood.

Objective: To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices.

Methods: Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form. Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation.

Results: Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective implementation activities and organized their everyday practice to support these activities. In other practices GPs discussed guidelines collectively but left the application up to the individual GP whilst others again saw no need for discussion or collective activities depending entirely on the individual GP's decision on whether and how to manage implementation.

Conclusion: Approaches to implementation of clinical guidelines vary substantially between practices. Supporting activities should take this into account.

Keywords: Clinical guidelines; general practice; general practitioners; implementation; qualitative research; quality of health care..