title: Primary care evidence in clinical guidelines: a mixed methods study of practitioners' views.
abstract: BACKGROUND
  Clinical practice guidelines are widely used in primary care, yet are not always based on applicable research.
  
  
  OBJECTIVE
  To explore primary care practitioners' views on the applicability to primary care patients of evidence underpinning National Institute for Health and Care Excellence (NICE) guideline recommendations.
  
  
  METHODS
  Delphi survey and focus groups in primary care, England, UK.
  
  
  METHODS
  Delphi survey of the perceived applicability of 14 guideline recommendations rated before and after a description of their evidence base, followed by two focus groups.
  
  
  RESULTS
  GPs significantly reduced scores for their perceived likelihood of pursuing recommendations after finding these were based on studies with low applicability to primary care, but maintained their scores for recommendations based on highly applicable research. GPs reported they were more likely to use guidelines where evidence was applicable to primary care, and less likely if the evidence base came from a secondary care population. Practitioners in the focus groups accepted that guideline developers would use the most relevant evidence available, but wanted clearer signposting of those recommendations particularly relevant for primary care patients. Their main need was for brief, clear, and accessible guidelines.
  
  
  CONCLUSIONS
  Guidelines should specify the extent to which the research evidence underpinning each recommendation is applicable to primary care. The relevance of guideline recommendations to primary care populations could be more explicitly considered at all three stages of guideline development: scoping and evidence synthesis, recommendation development, and publication. The relevant evidence base needs to be presented clearly and concisely, and in an easy to identify way.
authors.affiliation: Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Abdelhamid
authors.affiliation: Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Howe
authors.affiliation: Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Stokes
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Nadeem
authors.initials: N
authors.lastname: Qureshi
authors.affiliation: Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Steel
mesh_terms: D001291:Attitude of Health Personnel; D003697:Delphi Technique; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012052:Reimbursement, Incentive; D006113:United Kingdom
keywords: Delphi survey; National Institute for Health and Care Excellence; evidence base; focus groups; guidelines; primary care