Implementing evidence-based practice in primary care: perceptions of a multifaceted programme to encourage guideline use

Objective To explore the acceptability of the
various elements of a multifaceted intervention
designed to facilitate the process of guideline
implementation by primary care teams and to
understand constraints to the use of guidelines in
this setting.
Design A descriptive qualitative study using semistructured
group interviews.
Setting Primary care.
Participants 34 general practitioners (GPs), six
practice nurses and one practice manager were
involved in group interviews from ten general
practices.
Results The themes identi� ed re� ected the elements
of the intervention: bene� ts and problems
of critical appraisal workshops; perceptions of the
usefulness of guidelines; responses to audit feedback
and the impact of facilitation. Even where
practitioners were committed to guideline implementation
their use was not always straightforward.
Aspects such as the maintenance of a good
relationship with the patient and the in� uence of
colleagues in secondary care were seen as important.
Issues of time and resources were also
highlighted.
Conclusions Implementation of clinical guidelines
is a complex activity. Interventions used to
encourage their use should be � exible and directly
relevant to practical issues. Local ownership of the
process is important but agreed deadlines for
activity may be important to facilitate action.