title: Physicians' perceptions of barriers and facilitators regarding adoption of the National Cholesterol Education Program guidelines.
abstract: Despite the impact of high-visibility evidence-based clinical practice guidelines, physician adherence to guidelines remains low. This study explored primary care physicians' perceptions of barriers and facilitators in following the National Cholesterol Education Program guidelines. The authors conducted 9 focus groups and performed qualitative content analysis utilizing immersion-crystallization processes, codebooks, and qualitative coding software. Key barriers to implementing guidelines included the complexity and transience of existing cholesterol guidelines as well as perceived threats to multidimensional care of the patient that unifocal single-decision guidelines may create. Key facilitators included growing patient awareness regarding cholesterol, patients' willingness to take cholesterol medication, and technological breakthroughs. These findings have helped identify factors that prevent or enhance the adoption of cholesterol guidelines. While factors considered to be facilitators are significant, barriers may be sufficient to limit adherence. Opportunities may exist for improving adherence to cholesterol guidelines by providing training to providers and developing structural support through patient-physician activation tools.
authors.affiliation: Center for Primary Care and Prevention, The Warren Alpert Medical School of Brown University/Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA. donna_parker@brown.edu
authors.forename: Donna R
authors.initials: DR
authors.lastname: Parker
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Goldman
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: David
authors.initials: D
authors.lastname: Ahern
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Cover
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Borkan
mesh_terms: D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D006949:Hyperlipidemias / Q000517:prevention & control*; D008297:Male; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D014481:United States