Table 4 Examples of key recommendations and perceived barriers to adherence

Key recommendation 2 (Red eye):

Patients with a diffuse red eye, no itching, no alarming symptoms (pain, vision impairment, or photophobia), and no abnormalities of the cornea, have a likely diagnosis of infectious conjunctivitis. If the symptoms last shorter than 3 days or do not cause much discomfort, antibiotics are not necessary and a 'wait-and-see' strategy could be considered.

Most perceived barriers (> 35% of GPs) (n = 122):

Explanation:

   - Patient preferences (76%)

GPs may believe that the guideline recommendation is difficult to reconcile with patient preferences and

   - Lack of applicability to patients (46%)

demands, as patients often prefer, expect or demand antibiotics and do not rely on a 'wait-and-see' policy.

   - Patient ability and behaviour (39%)

In relation to this, GPs may believe that the recommendation is difficult to apply in practice as it does

Key recommendation 8 (CVA):

In the chronic phase of CVA (i.e. when no further improvements are to be expected) the GP provides information to the patients and their central caregivers with an emphasis on practical information that can contribute to a meaningful and satisfying daily life. They are also informed about activities of patient associations, peer groups, partner contacts, and educational meetings.

Most perceived barriers (> 35% of GPs) (n = 120):

Explanation:

   - Lack of time/time pressure (53%)

GPs may believe that adhering to this recommendation is difficult due to additional work demands compared

   - Lack of applicability general (48%)

to regular care. Therefore, they may think it is difficult to apply in practice. They may also believe that patients

   - Patient ability and behaviour (45%)

are unable to comply with the necessary actions. Furthermore, organisational constraints such as lack of

   - Organisational constraints (35%)

trained personnel or coordination with the activities performed by other healthcare providers

(e.g. specialists in hospitals) make it difficult to apply the recommendation in practice.

Key recommendation 10 (Thyroid disorder):

If the GP has specific knowledge on thyroid disorders, patients with hyperthyroïd (Graves disease) could be treated using the 'combination method'. This includes full inhibition of the thyroid function with a thyreostatic (preferably thiamazole 1dd30 mg), and then providing levothyroxine. Discuss the pros and cons of the treatment options (medication, radioactive iodine, surgery) with the patient and involve him or her in decision making.

Most perceived barriers (> 35% of GPs) (n = 129):

Explanation:

GPs may not feel confident with performing the recommendation in practice, as they lack appropriate

   - Lack of applicability (44%)

training or experience to treating patients with hyperthyroid. In relation to this, they may think that