Clinical guidelines: attitudes, information processes and culture in English primary care.

The application to clinical medicine of evidence-based clinical guidelines is an increasingly international policy prescription, yet research on how such guidelines might be implemented has tended to focus on change initiatives without seeking to understand change processes. This paper reports an empirical study of guideline implementation in UK general practice. Most GPs welcome guidelines as a means of improving care, though have reservations about their authority, relevance and effect on professional autonomy. 'Clan' organizational culture predominates and general practices do not generally have well-functioning internal arrangements for the management of clinical evidence and related information. We found no coherent relationships between these variables and practices' actual uptake of guidelines.

[1]  S. Harrison.  Knowledge into practice: what's the problem? , 1994, Journal of management in medicine.

[2]  C Langley,et al.  Use of guidelines in primary care--practitioners' perspectives. , 1998, Family practice.

[3]  M. Eccles.  North of England evidence based guidelines development project: summary version of evidence based guideline for the primary care management of stable angina , 1996 .

[4]  John Rohrbaugh,et al.  A Spatial Model of Effectiveness Criteria: Towards a Competing Values Approach to Organizational Analysis , 1983 .

[5]  A. Faulkner,et al.  General practitioners' use of guidelines in the consultation and their attitudes to them. , 1999, The British journal of general practice : the journal of the Royal College of General Practitioners.

[6]  C. Moorman.  Organizational Market Information Processes: Cultural Antecedents and New Product Outcomes , 1995 .

[7]  Jenny Field,et al.  General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey , 1998, BMJ.

[8]  A. Haines,et al.  Guidance on guidelines. , 1992, BMJ.

[9]  D. Sackett.  Evidence-Based Medicine: How to Practice and Teach EBM , 2018 .

[10]  S. Rogers,et al.  General practitioners' perceptions of effective health care , 1999, BMJ.

[11]  Duncan Cramer,et al.  Quantitative data analysis for social scientists , 1990 .

[12]  J. Lomas,et al.  From evidence to practice in the United States, the United Kingdom, and Canada. , 1993, The Milbank quarterly.

[13]  D. Campbell,et al.  EXPERIMENTAL AND QUASI-EXPERIMENT Al DESIGNS FOR RESEARCH , 2012 .

[14]  S. Harrison.  THE POLITICS OF EVIDENCE-BASED MEDICINE IN THE UNITED KINGDOM , 1998 .

[15]  R. Grol,et al.  Personal paper: Beliefs and evidence in changing clinical practice , 1997 .

[16]  K. Cameron.  Cultural Congruence, Strength, and Type: Relationships to Effectiveness , 1985 .

[17]  G. Huby,et al.  From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia , 1998, BMJ.

[18]  R. Fox.  Medical Uncertainty Revisited , 2000 .

[19]  A. Strauss,et al.  Basics of qualitative research: Grounded theory procedures and techniques. , 1992 .

[20]  Shan Cretin,et al.  Implementing clinical practice guidelines , 1999 .

[21]  M. Mugford,et al.  Effects of feedback of information on clinical practice: a review. , 1991, BMJ.

[22]  M. Robling,et al.  Why general practitioners and consultants change their clinical practice: a critical incident study , 1997, BMJ.

[23]  Amer A. Kaissi,et al.  Assessing the culture of medical group practices. , 1996, Medical care.

[24]  R Jones,et al.  A study of general practitioners' reasons for changing their prescribing behaviour , 1996, BMJ.

[25]  C. Mansfield,et al.  Attitudes and behaviors towards clinical guidelines: the clinicians' perspective. , 1995, Quality in health care : QHC.