General Practitioner preferences and use of evidence in clinical practice: a mixed methods study

Problem

General practitioners (GPs) aim to provide patient centred care combining clinical evidence, clinical judgement and patient priorities. Despite the widespread availability of clinical guidelines and the need for translation of evidence to support patient care, there are barriers to guideline use in general practice, including the availability of specific guidelines that address the complex care presenting to primary care. Determining GP requirements regarding evidence-based guidance, and their preferences on guideline topics and dissemination can help bridge the evidence to practice gap and support clinical decision making. The aims of this study were to: 1) ascertain the needs and preferences of GPs regarding evidence-based guidance to support patient care 2) prioritise content for future evidence-based guidance and 3) to optimise evidence-based guidance structure and dissemination.

Approach

This was a convergent parallel mixed methods study. A national GP survey was administered to 3496 Irish GPs through the GP professional body (Irish College of General Practitioners) in December 2020 and GP focus groups were conducted in April/May 2021. Integration of the quantitative and qualitative findings was undertaken at the interpretive level.

Findings

A total of 509 respondents completed the survey representing a response rate of 14.6%, which is in line with previous national surveys. Seven focus groups were undertaken with 40 GP participants. The national survey indicated that prescribing updates, interpretation of results, chronic disease management and older person care were the preferred topics for future evidence based guidance. Study participants indicated they require quick access to up-to-date and relevant evidence summaries online for use in clinical practice. Access to full reviews of topics for the purpose of continuing education and teaching was also a priority. Multiple modes of dissemination via email alerts, podcasts, videos and webinars were suggested to increase uptake of guidance in practice.

Consequences

To support the implementation of evidence based clinical practice, GPs require quick access to online, integrated and up-to-date evidence-based resources. They require evidence-based guidance that reflects the disease burden of the primary care population they care for and a multifaceted approach to dissemination of evidence is preferred. Our findings support development and implementation of evidence-based guidance on prioritised topics and the use of multimodal approaches for dissemination.