Why do GPs not implement evidence-based guidelines? A descriptive study

Abstract

Objectives. Our aim was to identify what is impeding GPs from pursuing currently recognized good practice and implementing evidence-based guidelines in their management of hypertension in the elderly. Method.We carried out a qualitative study using semi-structured interviews conducted during focus group outreach visits to 34 GPs from nine practices in Merseyside involved in an educational programme designed to improve the management of hypertension in the elderly.Results. Several barriers to the implementation of evidence-based guidelines in the management of hypertension in the elderly were identified. These included: doubts about the applicability of trial data to particular patients; the poor adherence of GPs to practice protocols; ageist attitudes of some GPs; the effect of time pressure and financial considerations making the subject a low priority; the absence of an effective computer system; and the absence of an educational mentor. All participants demonstrated a very positive attitude to practice-based education. They also welcomed external audit data, which compared their performance with that of other practices. Single-handed GPs were particularly enthusiastic about this approach as it provided them with the peer pressure they lacked. Conclusions.In order to bridge the gap between research and practice, educators need to address the various 'barriers to change' amongst practitioners.

Reasons for therapeutic inertia when managing hypertension in clinical practice in non-Western countries

“…The use of multiple measures has been shown to reduce this effect and policy makers and guideline authors should consider these aspects when setting BP goals. 24,25 The higher rate of diabetic patients not reaching the target BP is partly because of BP goals for this group being 10 mm Hg lower than in nondiabetic subjects and partly to a greater difficulty in managing hypertension in diabetes.…”

“…This is in contrast to a previous study that found that among medical practitioners BP goals for hypertensive patients were not tailored on individual risk stratification. 5 Cranney et al 24 identified several barriers to the implementation of evidence-based guidelines in the management of hypertension, including doubts about the applicability of trial data to particular patients, poor adherence of practice protocols and absence of an effective computer system or an educational mentor. Our findings suggest that a simple protocol may improve adherence to a practice protocol while serving as an educational tool.…”

“…However, many physicians feel that hypertension is not a priority, often because of lack of time or administrative burdens, or because of the growing number of important clinical areas. 24 Depending on the funding model, a specific reimbursement item for the management of hypertension that rewards physicians who apply treatment goals, possibly in conjunction with assisted management by a practice nurse or a pharmacist could result in improved achievements of treatment targets. 26,27 What is known about this topic:…”

Is qualitative research scientific, or merely relevant?

“…These findings might contribute to the understanding of why there is a gap between research and clinical practice. EBM is criticised for its lack of relevance in primary care, and also for its failure to consider the complexity in consultation (10). The qualitative abstract was considered relevant, but not very scientific.…”

Can psychological models bridge the gap between clinical guidelines and clinicians' behaviour? A randomised controlled trial of an intervention to influence dentists' intention to implement evidence-based practice

“…However, systematic reviews of such interventions have shown that increasing knowledge and skills is usually insufficient to achieve changes in clinical behaviour. [6][7][8][9][10] Yet, expensive implementation interventions continue to be developed and trialled using this unsuccessful paradigm. There is a need both for more effective methods of designing implementation interventions and for more efficient trial methods Although implementing guidelines often requires clinicians to change their behaviour, there is little evidence that psychological models of behaviour change have been applied to the design of implementation interventions; yet, these models have been suc-• Systematic reviews of guideline implementation trials have shown that increasing knowledge and skills through audit or education is generally insufficient to achieve significant changes in clinical practice.…”