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Why general practitioners do not implement evidence: qualitative study
1Somerset and North and East Devon Primary Care Research Network, Institute of General Practice, School of Postgraduate Medicine and Health Sciences, Exeter EX2 5DW. PCRN@exeter.ac.uk
Objectives:
To explore the reasons why general practitioners do not always implement best evidence.
Design:
Qualitative study using Balint-style groups.
Setting:
Primary care.
Participants:
19 general practitioners.
Main Outcome Measures:
Identifiable themes that indicate barriers to implementation.
Results:
Six main themes were identified that affected the implementation process: the personal and professional experiences of the general practitioners; the patient-doctor relationship; a perceived tension between primary and secondary care; general practitioners' feelings about their patients and the evidence; and logistical problems. Doctors are aware that their choice of words with patients can affect patients' decisions and whether evidence is implemented.
Conclusions:
General practitioner participants seem to act as a conduit within the consultation and regard clinical evidence as a square peg to fit in the round hole of the patient's life. The process of implementation is complex, fluid, and adaptive.