Table 7 Facilitators and barriers of guideline implementability as perceived by Family Physicians: PRACTICE ENVIRONMENT

Accessibility (N = 12)

Should be accessible (N = 3)

● Accessibility of the information is a factor that will impact on implementability {I-9}

Not accessible (N = 6)

● Guidelines are not accessible {FG1-P3}

● If I have to look for it, it will not happen as easily {FG2-P2}

● One thing I find difficult about using different guidelines is just finding them when I need them {Laughter} {I-8}

● It has to be something that can be handy and accessible {I-5}

● Guideline developers focus is the content of the recommendations not the accessibility or practicality of it, so they see it from a different perspective {FG4-P2}

Available at the point of care (POC) (N = 2)

● A useful guideline is one that is available at the POC - so that comes in either a convenient hard copy document that you can search very quickly as opposed to the diabetes guidelines which are several hundred pages. Osteoporosis has a little one-pager that was sent out with the journal {I-5}

● One of the barriers is not realizing that the guidelines are available {I-2}

● One of the big problems in terms of accessibility with guidelines, you’ve to find them, so are they there when you need them {I-1}

Timely access (N = 1)

● It should be timely in terms of my time and the time it takes to read it, and to have it so I can use it {I-10}

Implementation (N = 10)

-

-

Not enough time to use guidelines (N = 8)

● I don't have time to read the whole guideline {I-4}

● I don't have time, I'm, I am not seeing just hypertension patients, like the cardiologist so I don't have all the time to deal with all the details and all the facts, so guidelines should be thinking about our time {FG2-P2}

Too many guidelines (N = 4)

● There are so many of them [guidelines] and it's difficult to know which to follow because the easy ones you remember (e.g., Diabetes) because you know the ideal target;with hypertension, it tells you, this is my first choice, what should I do step by step, but I don’t think I will do that. {FG2-P2}

● There are too many guidelines to keep abreast {I-2}

Lack of support to implement (N = 1)

● We don’t have you know, enough support to help you know, explain all the things that we are doing so that the outcome is better {I-9}

Resource implications of following guidelines (N = 1)

● One barrier is resources – I don’t think the evidence is there or the system is ready for every single male patient over the age of 50 year to get screened for prostate cancer (i.e., PSA test). I don’t think Urologists would know how much volume they would get if every single patient was screened for PSA. {I-5}