What obstacles do general practitioners face in implementing guidelines for the management of depression?

Baker R., Reddish S., Robertson N. and Hearnshaw H. Eli Lilly National Clinical Audit Centre, Department of General Practice & Primary Health Care, Leicester University, UK.

Introduction/Objective: to identify the obstacles to change confronting general practitioners (GPs) asked to implement guidelines for the management of patients with depression.
Methods: (1) Interviews with GPs who have been asked to implement the guidelines. The interviews were transcribed and analysed, drawing on psychological theories of behaviour change; (2) extraction of data from the records of 7 newly diagnosed patients per GP to determine compliance with the guidelines. This is part of a randomised controlled trial of the effects of selecting implementation strategies according to the prevailing obstacles to change.
Results: 36 GPs have been interviewed. There were a wide variety of obstacles to change. Some GPs were not genuinely prepared to change; others had concerns about their ability to change. A particular problem concerned skills - the choice of phrases to ask about suicide risk or to inform about medication. There were also a small number of GPs whose personal problems were obstacles to change.
Discussion: An interview and record review is one method for identifying the obstacles. There were a wide variety of obstacles to implementing guidelines for depression among GPs. The use of a single implementation strategy would not be appropriate to them all.

Amsterdam 1997 010.05