Carlsen Benedicte, Norheim Ole F
Stein Rokkan Centre for Social Studies, The University of Bergen, Bergen, Norway.
BMC Health Serv Res. 2008 Oct 22;8:218. doi: 10.1186/1472-6963-8-218.
General practitioners (GPs) adopt clinical practice guidelines to varying degrees. Several factors have been found to influence application of guidelines in practice and the GP is apparently the key actor. Studies are needed to increase our understanding of how GPs' attitudes influence their use of guidelines. In this study we explored GPs' attitudes to guidelines.
In 2007 we conducted six semi-structured group interviews with a purposive sample of 27 Norwegian GPs. The participants were encouraged to discuss guidelines they were familiar with, the evidence base of guidelines, professional autonomy and doctor-patient relations. We used thematic content analysis to extract central themes and arguments.
When deciding whether tfollow guideline recommendations, GPs consider whether guidelines are trustworthy, whether they suit patients and whether the recommended action is feasible. There were two important findings. First, the GP's were concerned that guidelines may be more heavily influenced by economic considerations than clinical ones. Second, in contrast to earlier findings, changes in recommendations and disagreement between experts were mostly viewed positively.
This study underscores the need for transparency in the process of development and implementation of guidelines. To enhance the use of guidelines, primary care physicians should be involved in the process of developing guidelines and the process should be transparent and explicit regarding the evidence base and economic considerations.
全科医生（GPs）对临床实践指南的采用程度各不相同。已发现若干因素会影响指南在实践中的应用，而全科医生显然是关键因素。需要开展研究以增进我们对全科医生态度如何影响其对指南使用的理解。在本研究中，我们探讨了全科医生对指南的态度。
2007年，我们对27名挪威全科医生进行了有目的抽样的六次半结构化小组访谈。鼓励参与者讨论他们熟悉的指南、指南的证据基础、职业自主性和医患关系。我们使用主题内容分析法提取核心主题和论据。
在决定是否遵循指南建议时，全科医生会考虑指南是否值得信赖、是否适合患者以及推荐的行动是否可行。有两个重要发现。首先，全科医生担心指南可能受经济因素影响大于临床因素。其次，与早期研究结果相反，建议的变化和专家之间的分歧大多被视为积极的。
本研究强调了指南制定和实施过程中透明度的必要性。为了加强指南的使用，基层医疗医生应参与指南制定过程，并且该过程在证据基础和经济考虑方面应透明且明确。
