title: The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms.
abstract: OBJECTIVE
  To identify the relevant barriers and enablers perceived by primary care professionals in implementing the recommendations of clinical practice guidelines (CPG).
  
  
  METHODS
  Two focus groups were conducted with primary care physicians and nurses in Catalonia (Spain) between October and December 2012. Thirty-nine health professionals were selected based on their knowledge and daily use of CPG. Finally, eight general practitioners and eight nurses were included in the discussion groups. Participants were asked to share their views and beliefs on the accessibility of CPG, their knowledge and use of these documents, the content and format of CPG, dissemination strategy, training, professional-patient relationship, and the use of CPG by the management structure. We recorded and transcribed the content verbatim and analysed the data using qualitative analysis techniques.
  
  
  RESULTS
  Physicians believed that, overall, CPG were of little practical use and frequently referred to them as a largely bureaucratic management control instrument that threatened their professional autonomy. In contrast, nurses believed that CPG were rather helpful tools in their day-to-day practice, although they would like them to be more sensitive to the current role of nurses. Both groups believed that CPG did not provide a response to most of the decisions they faced in the primary care setting.
  
  
  CONCLUSIONS
  Compliance with CPG recommendations would be improved if these documents were brief, non-compulsory, not cost-containment oriented, more based on nursing care models, sensitive to the specific needs of primary care patients, and integrated into the computer workstation.
authors.affiliation: Department of Public Health, University of Barcelona, Barcelona, Spain; CAPSE - Catalan Institute of Health, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Gené-Badia
authors.affiliation: Department of Sociology and Organizational Analysis, University of Barcelona, Barcelona, Spain. Electronic address: pgallodep@ub.edu.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gallo
authors.affiliation: Department of Sociology and Organizational Analysis, University of Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Caïs
authors.affiliation: Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain.
authors.forename: Emília
authors.initials: E
authors.lastname: Sánchez
authors.affiliation: TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Agency for Healthcare Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Carrion
authors.affiliation: Department of Sociology and Organizational Analysis, University of Barcelona, Barcelona, Spain.
authors.forename: Liliana
authors.initials: L
authors.lastname: Arroyo
authors.affiliation: TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain; Health Sciences Department, Universitat Oberta de Catalunya, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Aymerich
mesh_terms: D001291:Attitude of Health Personnel; D017144:Focus Groups; D019983:Guideline Adherence; D006301:Health Services Needs and Demand; D006801:Humans; D058007:Physicians, Primary Care / Q000523:psychology*; D017410:Practice Guidelines as Topic; D059017:Primary Care Nursing / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D013030:Spain
keywords: Atención primaria; Evidence-based medicine; Investigación cualitativa; Medicina basada en la evidencia; Pago por resultados; Pay for performance; Primary health care; Qualitative research