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