What is the significance of guidelines in the primary care setting?

Abstract

SummaryMedical guidelines aim to ensure that care processes take place in an evidence-based and structured manner. They are especially relevant in outpatient primary care due to the wide range of symptoms and clinical pictures. In German-speaking countries, there is a lack of current findings documenting general practitioners’ opinions and experiences regarding guidelines, their expectations and their views on what improvements could be made to increase the use of this type of evidence-based instrument in the primary care setting. Between April and August 2020, a total of 3098 general practitioners were surveyed in the states of Baden–Württemberg, Hesse and Rhineland–Palatinate via an online questionnaire. Alongside the descriptive evaluation, t‑testing was used to determine significant differences between two independent sampling groups. A factor analysis was also used to cluster the expectations of those surveyed regarding the fulfilment of requirements relating to guidelines. A total of 52% of those surveyed have a positive view of guidelines. Overall, guidelines are associated with an increased evidence-based approach (69%), standardisation of diagnosis and treatment (62%) and a reduction in overprovision or underprovision of care (57%). In all, 62% of the physicians who implemented guidelines observed positive effects on the quality of care provided, and 67% reported that the implementation of guidelines improved the quality of their diagnostic or therapeutic skills. However, implementation is often seen as being complicated (43%) and restricting the physician’s ability to act independently (63%). Survey participants suggested that guidelines could be optimised by giving greater consideration to nondrug alternatives (46%), focusing on issues related to quality of life (42%) and offering a comparative assessment of various treatment options (39%). In order to further promote the attractiveness of guidelines for primary care the design of guidelines should be oriented more towards their application; they should be well-presented to make them easier to implement. The scope of action available to the physician should be stressed. The guidelines should provide recommendations on opportunities for the delegation of tasks within practice teams.

Primary care involvement in clinical research – prerequisites, motivators, and barriers: results from a study series

“…Urban physicians in the quantitative survey sample [ 30 ] identified clear benefits from clinical studies and cRCTs, but their rural counterparts took a more cautious stance. This tallies with the general research findings that GPs in rural areas perceive lower added value in evidence-based structures and instruments [ 39 , 40 ]. Likewise, most of the 24% of respondents having already taken part in cRCTs were located in urban areas with a greater variety of care services, which is often a prerequisite in effective clinical research [ 7 , 9 ].…”

“…The results from the survey may be seen as confirmation of increased willingness amongst GPs to participate in empirical, evidence-oriented studies with the aim of optimising healthcare [ 15 ]. Especially younger GPs in urban catchment areas are increasingly basing their work on standardised, evidence-based interventions [ 39 , 40 ]. Even so, a substantial proportion of general medical practices are fundamentally unwilling or remain reluctant regarding these research projects [ 1 , 7 – 9 ].…”

“…GPs expressed a desire for a manageable and predictable additional workload such as in the complexity of the intervention to be used and in administrative and documentation tasks without excessively interfering with established practice routines [ 36 , 39 , 40 , 49 ]. GPs also wished for more individual flexibility in action and decision-making extending beyond participation in research activities to involvement in evidence-based structures and instruments such as disease management programmes and guidelines.…”

“…Questionnaires and interview guidelines were developed for the quantitative and qualitative surveys on GPs as to their general participation and willingness to participate in clinical research and cRCTs; these questionnaires and guidelines took into account the authors’ previous research and recruitment experience in the Innovation Fund and evidence-based instruments [ 36 – 40 ] and general desk research (including Lech et al [ 1 ] and Heytens et al [ 34 ]). Both the quantitative main survey and the qualitative study contain the following main content areas: a) attitudes towards clinical research projects and their benefits; b) willingness to participate and corresponding prerequisites; c) experiences from taking part in specific projects; d) perceived optimisation potential.…”

The Reasons for the Low Uptake of New Antidiabetic Drugs with Cardiovascular Effects—A Family Doctor Perspective

“…Overall, clinical guidelines are generally not designed to suit the working style of primary care providers and family physicians [ 39 , 44 ]. In addition, there is a lack of competency-based workflow and effective communication models between different disciplines, which can also contribute to the non-adherence of family physicians to the guidelines [ 41 ].…”