title: Experimenting clinical pathways in general practice: a focus group investigation with italian general practitioners.
abstract: BACKGROUND
  Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners' (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs' involvement in the care of their patients, and improving both patients' and professionals' satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008.
  
  
  METHODS
  Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach.
  
  
  RESULTS
  FOUR MAJOR THEMES EMERGED: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs' role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity.
  
  
  CONCLUSIONS
  Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs' adherence and commitment.
  
  
  BACKGROUND
  the Authors thank Dr. AP. Cantù and Dr D. Cereda who participated in the two focus groups as observers.
authors.affiliation: Department of Biomedical Sciences for Health University of Milano.
authors.forename: Lucia
authors.initials: L
authors.lastname: Zannini
authors.affiliation: Department of Biomedical Sciences for Health University of Milano.
authors.forename: Cesarina
authors.initials: C
authors.lastname: Cattaneo
authors.affiliation: Department of Biomedical Sciences for Health University of Milano.
authors.forename: Paolo
authors.initials: P
authors.lastname: Peduzzi
authors.affiliation: Health Management Unit A5L Monza Brianza.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lopiccoli
authors.affiliation: Department of Biomedical Sciences for Health University of Milano ; Foundation IRCCS Ca' Cranda Ospedale Maggiore Policlinico, Milano, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Auxilia
keywords: clinical governance; clinical pathways; continuing professional development; focus group; general practice