Factors influencing the use of clinical guidelines by general practitioners working in a setting of complex multimorbidity: a case study by interviews

Jones, Jeremy A., and Reeve, Carole A. (2018) Factors influencing the use of clinical guidelines by general practitioners working in a setting of complex multimorbidity: a case study by interviews. BMC Family Practice, 19. 157.

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Background: The Central Australian Remote Practitioners Association Standard Treatment Manual (CARPA) contains protocols for primary health care in remote Central Australia. This context stands in stark contrast to the mainstream settings in Australia and features an Aboriginal population with very poor health status, powerful social determinants of health, geographical isolation and high turnover of health practitioners. The manual consolidates the core elements of national guidelines, particularly as they pertain to Aboriginal health care, into a single document. The aim of this study is to explore factors that promote or impede the use of CARPA by general practitioners (GPs) in Central Australia, with a particular focus on chronic disease management.

Methods: In-depth interviews were conducted with GPs and GP registrars employed in the provision of Aboriginal health care in Central Australia. Interview transcripts were thematically analysed from a critical theory perspective.

Results: 11 GPs and 3 GP registrars from the two major Aboriginal primary health services in Central Australia were interviewed. The dominant theme in the data was that poor continuity of care impeded the use of CARPA. The second-most dominant theme was that electronic health record systems enhanced the use of CARPA in some ways, and impeded its use in others. Other factors influencing the use of CARPA included the culture of the health service organisation, GPs' first impressions of CARPA, the accessibility and usability of CARPA, and GPs' confidence practicing in such a unique environment.

Conclusions: This study identifies factors from multiple domains that influence the use of best practice guidelines in the delivery of chronic disease care. It demonstrates that such factors may not be purely 'enablers' or 'barriers', but may be a mixture of both. It highlights the critical role of continuity of care and the potential benefits and pitfalls of using electronic health records in providing chronic disease care. This study provides empirical insights that can be used to improve chronic disease care.

Item ID: 55754
Item Type: Article (Research - C1)
ISSN: 1471-2296
Keywords: Chronic disease, Guidelines, Aboriginal, Continuity of care, Electronic health records, Implementation
Copyright Information: © The Author(s). 2018. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Funders: Northern Territory General Practice Education (NTGPE), Australian General Practice Training (AGPT) Program
Date Deposited: 03 Oct 2018 07:52
FoR Codes: 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 50%
42 HEALTH SCIENCES > 4203 Health services and systems > 420306 Health care administration @ 50%
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