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.
Dowswell
G
G
Department of Applied Social Science, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK.
Harrison
S
S
Wright
J
J
D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine; D006801:Humans; D015279:Organizational Culture; D010821:Physicians, Family / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D006113:United Kingdom