Clinical practice guidelines' development and use in New Zealand: an evolving process.
OBJECTIVE
This study explores the use of evidence-based guidelines by New Zealand general practitioners, and describes strategies developed to overcome identified barriers in the New Zealand setting.


METHODS
In-depth, semi-structured interviews with a purposeful sample of New Zealand guideline stakeholders including policy makers and general practitioners. Data were analysed using inductive thematic analysis. Feedback of emergent themes to the New Zealand Guidelines Group (NZGG) and further collaboration resulted in strategies to overcome barriers to use, some of which have now been implemented.


RESULTS
At the time of the research (2000/2001), general practitioners reported that they did not regularly use guidelines to support decision-making regarding patient care. Reasons given included guidelines formats not being recognisable or user-friendly, lack of general practitioner involvement in prioritisation and development processes, influence of stakeholders, and recommendations not being accessible or relevant. Policy and other interviewed stakeholders reported general acceptance of guidelines, however there were minimal interfaces between the NZGG and these organisations.


CONCLUSIONS
Effective implementation of guidelines requires more than guidelines endorsement by policy stakeholders and passive dissemination strategies, but rather an understanding of the issues facing general practitioners and their attitudes to guideline use.
McKinlay
Eileen
E
Department of General Practice, Wellington School of Medicine and Health Sciences, Otago University, Wellington, New Zealand. emckinlay@wnmeds.ac.nz
McLeod
Deborah
D
Dowell
Antony
A
Marshall
Catherine
C
D001291:Attitude of Health Personnel; D003657:Decision Making; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D009520:New Zealand; D010821:Physicians, Family / Q000523:psychology; D017410:Practice Guidelines as Topic