Liz Smith1, Anne Walker, Ken Gilhooly. 1. Manchester Centre for Healthcare Management, University of Manchester, Devonshire House, University Precinct Centre, Oxford Road, Manchester M13 9PL, UK. lsmith@dom01.mbs.ac.uk
Abstract
BACKGROUND: Clinical guidelines have become an increasingly familiar component of health care, although their passive dissemination does not ensure implementation. This study is concerned with general practitioners' (GPs) views of guideline implementation in general practice. It focuses specifically on their views about guidelines for the management of patients with depression. OBJECTIVE: To elicit and explore GPs' views about clinical guidelines for the management of depression, their use in practice, barriers to their use, and how best to implement guidelines. DESIGN: Qualitative study using in-depth interviews with a purposive sample of GPs. SETTING: General Practices across the Scottish Grampian region, and Northeast England. METHODS: Eleven GPs who had participated in a previous questionnaire based depression study were interviewed. Interviews were transcribed and analyzed using the "framework technique." RESULTS: Several participating GPs did not agree with recommendations of the current depression guidelines; some thought they were insufficiently flexible to use with the variety of patients they see. The volume of guidelines received, lack of time and resources (particularly mental health professionals for referrals) were seen as the main barriers to guideline use. CONCLUSIONS: A range of factors contributes to variability in compliance with guidelines for the management of depression. For guideline use to increase, GPs in this study said they would like to see more resources put in place; a reduction in the number of guidelines they receive; incorporation of guideline recommendations onto computer decision support systems; and regular audit and feedback to allow them to monitor their practice.
BACKGROUND: Clinical guidelines have become an increasingly familiar component of health care, although their passive dissemination does not ensure implementation. This study is concerned with general practitioners' (GPs) views of guideline implementation in general practice. It focuses specifically on their views about guidelines for the management of patients with depression. OBJECTIVE: To elicit and explore GPs' views about clinical guidelines for the management of depression, their use in practice, barriers to their use, and how best to implement guidelines. DESIGN: Qualitative study using in-depth interviews with a purposive sample of GPs. SETTING: General Practices across the Scottish Grampian region, and Northeast England. METHODS: Eleven GPs who had participated in a previous questionnaire based depression study were interviewed. Interviews were transcribed and analyzed using the "framework technique." RESULTS: Several participating GPs did not agree with recommendations of the current depression guidelines; some thought they were insufficiently flexible to use with the variety of patients they see. The volume of guidelines received, lack of time and resources (particularly mental health professionals for referrals) were seen as the main barriers to guideline use. CONCLUSIONS: A range of factors contributes to variability in compliance with guidelines for the management of depression. For guideline use to increase, GPs in this study said they would like to see more resources put in place; a reduction in the number of guidelines they receive; incorporation of guideline recommendations onto computer decision support systems; and regular audit and feedback to allow them to monitor their practice.
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