Why general practitioners do not implement evidence: qualitative study

doi:10.1136/bmj.323.7321.1100

BMJ 2001;323:1100 ( 10 November )

Primary care

Why general practitioners do not implement evidence: qualitative study

A C Freeman, general practice research facilitator, K Sweeney, general practice research facilitator.

Somerset and North and East Devon Primary Care Research Network, Institute of General Practice, School of Postgraduate Medicine and Health Sciences, Exeter EX2 5DW

Correspondence to: A C Freeman PCRN{at}exeter.ac.uk

Objectives: To explore the reasons why general practitionersdo not always implement bestevidence.
Design: Qualitative study using Balint-stylegroups.
Setting: Primarycare.
Participants: 19 generalpractitioners.
Main outcome measures: Identifiable themes that indicate barrierstoimplementation.
Results: Six main themes were identified that affectedthe implementation process: the personal and professional experiencesof the general practitioners; the patient-doctor relationship;a perceived tension between primary and secondary care; generalpractitioners' feelings about their patients and the evidence;and logistical problems. Doctors are aware that their choice ofwords with patients can affect patients' decisions and whetherevidence isimplemented.
Conclusions: General practitioner participants seem toact as a conduit within the consultation and regard clinical evidenceas a square peg to fit in the round hole of the patient's life.The process of implementation is complex, fluid, andadaptive.

What is already known on this topic
General practitioners do not always act on evidence in clinical practice

General practitioners are reluctant to jeopardise their relationship with the patient and sometimes feel that patients are unwilling to take drugs

What this study adds
Implementation of evidence by general practitioners is a complex and fluid process

Decisions are influenced by the doctor's personal and professional experience as well as by their knowledge of and relationship with the patient

Doctors' choice of words can influence patients' decisions about treatment

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