title: Swedish general practitioners' attitudes towards treatment guidelines - a qualitative study.
abstract: BACKGROUND
  Drug therapy in primary care is a challenge for general practitioners (GPs) and the prescribing decision is influenced by several factors. GPs obtain drug information in different ways, from evidence-based sources, their own or others' experiences, or interactions with opinion makers, patients or colleagues. The need for objective drug information sources instead of drug industry-provided information has led to the establishment of local drug and therapeutic committees. They annually produce and implement local treatment guidelines in order to promote rational drug use. This study describes Swedish GPs' attitudes towards locally developed evidence-based treatment guidelines.
  
  
  METHODS
  Three focus group interviews were performed with a total of 17 GPs working at both public and private primary health care centres in Skåne in southern Sweden. Transcripts were analysed by conventional content analysis. Codes, categories and themes were derived from data during the analysis.
  
  
  RESULTS
  We found two main themes: GP-related influencing factors and External influencing factors. The first theme emerged when we put together four main categories: Expectations and perceptions about existing local guidelines, Knowledge about evidence-based prescribing, Trust in development of guidelines, and Beliefs about adherence to guidelines. The second theme included the categories Patient-related aspects, Drug industry-related aspects, and Health economic aspects. The time-saving aspect, trust in evidence-based market-neutral guidelines and patient safety were described as key motivating factors for adherence. Patient safety was reported to be more important than adherence to guidelines or maintaining a good patient-doctor relationship. Cost containment was perceived both as a motivating factor and a barrier for adherence to guidelines. GPs expressed concerns about difficulties with adherence to guidelines when managing patients with drugs from other prescribers. GPs experienced a lack of time to self-inform and difficulties managing direct-to-consumer drug industry information.
  
  
  CONCLUSIONS
  Patient safety, trust in development of evidence-based recommendations, the patient-doctor encounter and cost containment were found to be key factors in GPs' prescribing. Future studies should explore the need for transparency in forming and implementing guidelines, which might potentially increase adherence to evidence-based treatment guidelines in primary care.
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. veronica.milos@med.lu.se.|Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Skåne University Hospital, building 28, floor 11, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. veronica.milos@med.lu.se.
authors.forename: Veronica
authors.initials: V
authors.lastname: Milos
authors.affiliation: Medical Products Agency, Department of Medicine Usage, Uppsala and Sahlgrenska Academy, Department of Public Health and Community Medicine, Unit of Social Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. tommy.westerlund@mpa.se.
authors.forename: Tommy
authors.initials: T
authors.lastname: Westerlund
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. patrik.midlov@med.lu.se.
authors.forename: Patrik
authors.initials: P
authors.lastname: Midlöv
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden. eva-lena.strandberg@med.lu.se.
authors.forename: Eva Lena
authors.initials: EL
authors.lastname: Strandberg
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004358:Drug Therapy / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D013548:Sweden