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 semi-structured 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 identified reflected the elements of the intervention: benefits 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 influence 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 flexible and directly relevant to practical issues. Local ownership of the process is important but agreed deadlines for activity may be important to facilitate action.