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Evidence into practice: a theory based study of achieving national health targets in primary care.
J Eval Clin Pract. 2004 Aug; 10(3):447-56.JE

Abstract

RATIONALE, AIMS AND OBJECTIVES

This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful.

METHODS

Sixteen London GPs were interviewed, eight 'high implementers' (having met five or more of six CHD NSF milestones) and eight 'low implementers' (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA).

RESULTS

There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones. Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care.

CONCLUSIONS

This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care.

Authors+Show Affiliations

Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, UK. s.michie@ucl.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15304145

Citation

Michie, Susan, et al. "Evidence Into Practice: a Theory Based Study of Achieving National Health Targets in Primary Care." Journal of Evaluation in Clinical Practice, vol. 10, no. 3, 2004, pp. 447-56.
Michie S, Hendy J, Smith J, et al. Evidence into practice: a theory based study of achieving national health targets in primary care. J Eval Clin Pract. 2004;10(3):447-56.
Michie, S., Hendy, J., Smith, J., & Adshead, F. (2004). Evidence into practice: a theory based study of achieving national health targets in primary care. Journal of Evaluation in Clinical Practice, 10(3), 447-56.
Michie S, et al. Evidence Into Practice: a Theory Based Study of Achieving National Health Targets in Primary Care. J Eval Clin Pract. 2004;10(3):447-56. PubMed PMID: 15304145.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence into practice: a theory based study of achieving national health targets in primary care. AU - Michie,Susan, AU - Hendy,Jane, AU - Smith,Jonathan, AU - Adshead,Fiona, PY - 2004/8/12/pubmed PY - 2004/12/16/medline PY - 2004/8/12/entrez SP - 447 EP - 56 JF - Journal of evaluation in clinical practice JO - J Eval Clin Pract VL - 10 IS - 3 N2 - RATIONALE, AIMS AND OBJECTIVES: This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful. METHODS: Sixteen London GPs were interviewed, eight 'high implementers' (having met five or more of six CHD NSF milestones) and eight 'low implementers' (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA). RESULTS: There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones. Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care. CONCLUSIONS: This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care. SN - 1356-1294 UR - https://www.unboundmedicine.com/medline/citation/15304145/Evidence_into_practice:_a_theory_based_study_of_achieving_national_health_targets_in_primary_care_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1356-1294&date=2004&volume=10&issue=3&spage=447 DB - PRIME DP - Unbound Medicine ER -