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Br J Gen Pract. 1995 December; 45(401): 643–647.
PMCID: PMC1239465

Clinical guidelines in primary care: a survey of general practitioners' attitudes and behaviour.

Abstract

BACKGROUND: In the United Kingdom little is known about general practitioners' attitudes to and behaviour concerning clinical guidelines. AIM: A study was performed to investigate these two under-researched areas. METHOD: In 1994 a postal questionnaire on clinical guidelines was sent to all 326 general practitioner principals on the list of Lincolnshire Family Health Services Authority. The questionnaire consisted of 20 attitude statements and an open question on clinical guidelines, as well as surveying characteristics and behaviour of respondents. RESULTS: Of the 326 general practitioners sent questionnaires, 213 (65%) replied. Most respondents (78%) reported having been involved in writing inhouse guidelines. An even greater proportion (92%) reported having participated in clinical audit. Respondents were generally in favour of clinical guidelines, with mean response scores indicating a positive attitude to guidelines in 15 of the 20 statements, a negative attitude in four and equivocation in one. The majority of respondents felt that guidelines were effective in improving patient care (69%). Members (or fellows) of the Royal College of General Practitioners had a more positive attitude than non-members towards guidelines. They were also significantly more likely than non-members to have written inhouse guidelines, as were those who had participated in audit compared with those who had not participated in audit. A substantial minority (over a quarter) of general practitioners were concerned that guidelines may be used for setting performance-related pay, or that they may lead to 'cookbook' medicine, reduce clinical freedom or stifle innovation. There was also concern that guidelines should be scientifically valid. CONCLUSION: This study suggests that many general practitioners in the Lincolnshire Family Health Services Authority area have produced written inhouse guidelines. This is largely sustained by positive attitudes about the effectiveness and benefits of clinical guidelines. The positive attitude of RCGP members supports it in its continuing role in developing, implementing and evaluating guidelines in primary care. The question of whether incorporation of guidelines into clinical audit is an effective means to disseminate systematic research-based guidelines warrants further study.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Farmer A. Setting up consensus standards for the care of patients in general practice. Br J Gen Pract. 1991 Apr;41(345):135–136. [PMC free article] [PubMed]
  • Moher M, Johnson N. Use of aspirin by general practitioners in suspected acute myocardial infarction. BMJ. 1994 Mar 19;308(6931):760–760. [PMC free article] [PubMed]
  • Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. [PubMed]
  • Haines A, Feder G. Guidance on guidelines. BMJ. 1992 Oct 3;305(6857):785–786. [PMC free article] [PubMed]
  • Conroy M, Shannon W. Clinical guidelines: their implementation in general practice. Br J Gen Pract. 1995 Jul;45(396):371–375. [PMC free article] [PubMed]
  • Grol R. National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. Br J Gen Pract. 1990 Sep;40(338):361–364. [PMC free article] [PubMed]
  • Grol R. Implementing guidelines in general practice care. Qual Health Care. 1992 Sep;1(3):184–191. [PMC free article] [PubMed]
  • Farmer A. Medical practice guidelines: lessons from the United States. BMJ. 1993 Jul 31;307(6899):313–317. [PMC free article] [PubMed]
  • Tunis SR, Hayward RS, Wilson MC, Rubin HR, Bass EB, Johnston M, Steinberg EP. Internists' attitudes about clinical practice guidelines. Ann Intern Med. 1994 Jun 1;120(11):956–963. [PubMed]
  • Pringle M, Robins S, Brown G. Computers in the surgery. The patient's view. Br Med J (Clin Res Ed) 1984 Jan 28;288(6413):289–291. [PMC free article] [PubMed]
  • Delamothe T. Wanted: guidelines that doctors will follow. BMJ. 1993 Jul 24;307(6898):218–218. [PMC free article] [PubMed]
  • Littlejohns P, Collier J, Hilton S. Guidance on guidelines. BMJ. 1992 Oct 31;305(6861):b1098–1098. [PMC free article]
  • Bunker JP. Can professionalism survive in the marketplace? BMJ. 1994 May 7;308(6938):1179–1180. [PMC free article] [PubMed]
  • Feder G. Clinical guidelines in 1994. BMJ. 1994 Dec 3;309(6967):1457–1458. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners