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Table 2 Facilitators and barriers of guideline implementability as perceived by Family Physicians: FORMAT

From: The development of a guideline implementability tool (GUIDE-IT): a qualitative study of family physician perspectives

Facilitators (Number of respondents) Utterance example Barriers (Number of respondents) Utterance example
Format type
  Summaries (N = 8) It would be helpful to have a quick summary because the guideline will be read at one point but not while the patient is there. {I-8} If no summary pages (N = 1) If there was no summary pages provided {FG4-P2}
Charts or tables (N = 5) Tabular form would be the most useful because it is very clear. {I-3} - -
I appreciate having tables, charts, flow charts - I usually refer to these {I-4}   
Algorithms or flowcharts (N = 3) If I can't discern where the guideline's direction is then that's how you know that sometimes algorithms are really much more helpful because we only have maybe 10, 15 minutes per patient. {FG1-P2} Algorithms/Flowcharts (N = 3) Flowcharts are too complex and confusing {FG4-P2}
Clear decision trees in terms of how to go through management decision making processes. {I-1}   I am not crazy about algorithms – it takes a while to get through it; Even if the guideline is no longer than 15 pages, if there are a lot of algorithms and a lot of text, it sort of goes out of my mind. – I don’t like them and find the print too small {I-3}
Flow sheets (N = 3) A great tool is flow sheets that can be incorporated into practice and be used to track patients' progress according to guideline recommendations, it’s easy to use and follow {I-1} - -
Books or booklets (N = 2) The guidelines I use more frequently are in a booklet form with an index so you can look up what you want {I-3} Booklets (N = 1) I get turned off very quickly if I get booklets {FG1-P2}’
If you provide booklets, have it colour coordinated {FG2-P2}
Laminated cards (N = 1) Guidelines boiled down to a one page laminated card that is easy to use (e.g., diabetes flow sheet published by the ministry) {I-1} - -
Checkboxes (N = 1) Checkboxes are wonderful - having clear check boxes or something to say that the test was completed and indicative of the diagnosis; have some of the checklists compatible to billing purposes {I-2} - -
Desk calendar (N = 1) A desk calendar format (e.g., diabetes guidelines) is user-friendly, readable but evidence-based and accessible as it can go on a desk or shelf as a visual reminder of the guideline. {FG1-P3} - -
Organization (N = 16)
  Provide a stepwise approach (N = 2) Guidelines are useful if they provide a staged, progressive approach so if you are stuck you can keep going through stages {FG3-P1} - -
Provide information as done in lab reports (N = 2) I wouldn't be able to recall the numbers and ranges from cholesterol and diabetes guideline, but they are in every lab report so I can't help but use them and discuss with patients - why can't guidelines do the same? {FG2-P2} - -
Organize sequentially (N = 1) Guideline recommendations should be sequential - it should say why we're choosing this particular option (we can go this way or that way) {I-7} - -
Organize according to patient presentation (N = 1) Having materials well organized into blocks of presentation: presenting complaint, family history, reason for problem {I-2} - -
Organize according to what patients may ask (N = 1) Methods of presentation that geared toward questions that patients are likely to ask {I-1} - -
Have a structured approach (N = 1) Having a structured approach so that no detail is forgotten. {I-2} - -
Divide information according to sub-specialty (N = 1) I can't keep track of all the names of the studies - ones from cardiovascular, osteoporosis, diabetes. So, they could be divided up according to sub-specialty {FG2-P1} - -
Characterize drugs by type of patient (N = 1) I like the ones that integrate into the way do things anyway (which drug to choose first, like in hypertension). It lays it out clearly and characterize the type of patient that would do better with this vs that drug {I-8} - -
Provide e-link to more evidence (N = 1) Provide an e-link to the evidence so that doc can verify appropriateness of recommendation for their patient; include outcomes with links to evidence supporting recommendations; for reassurance of recommendation and for use to educate patients {FG1-P2} - -
Provide suggestions with links (N = 1) Provide suggestions with links so it can be drilled down {FG1-P1} - -
Provide abbreviated explanation of evidence (N = 1) Could provide an addendum of a very simplified version of the more popular studies - an abbreviated explanation of the study and its findings {FG2-P1} - -
Presentation (N = 13)
  Clear layout (N = 2) Clearly and accessibly laid out for management {I-1} - -
Short (N = 2) Short guidelines (3 pages) are easy to read, understand and implement (the way old diabetes guidelines used to be) {I-6} Too big/too long (N = 7) It’s frustrating when they are super big {FG4-P1}
If it has 4 or more pages, I don’t even look at it {FG2-P2}
Pleasing to the eye (N = 1) Methods of presentation that are pleasing to the eye {I-1} - -
Presentation makes sense (N = 1) Methods of presentation that make sense {I-1} - -
Delivery (N = 4)
  Provide a central resource (a one-stop-shop) for guidelines (N = 3) The ideal guideline would be a one-stop-shop like "Up-to-date" which I use because I know I just go there and get the answer.; I would love to have a central resource which contains all of the most trusted and strongest guidelines, where I can go, search the information I want and have the answer pop up {I-1} - -
Provide online table of contents (N = 1) Include an online table of contents where you can quickly get to the info and click the section you are looking for {I-5} - -
Sections (N = 6)
  Include a background (N = 1) Provide background {I-1} - -
Include purpose of the guideline (N = 1) Simple articulation of the purpose of the guideline is extremely important {I-2} - -
Include clear outcomes (N = 1) Include clear outcomes {FG1-P2} - -
Provide a clear recommendation section (N = 1) They have a very clear recommendation section at the end of any article that you can always flip to and then go back, they will also have a lot of the supporting evidence there so it kind of provides a nice balance in that way {I-1}   
Provide a clear index page (N = 1) Provide a clear index page {I-9}   
Include templates to prompt for history (N = 1) Providing a template of information to prompt for family history or date of last check up or other details and comprehensive review of the problem would facilitate the use of guidelines and make more time for family doc {I-2} - -
Platform (N = 4)
  Electronic (N = 3) Having it online at some free location where you don't have to login would be good {I-5} - -
Paper-based (N = 1) A useful guideline is one that is available at the POC - so that comes in either a convenient hard copy document (e.g., CHEP, which has the summary packet on hypertension guidelines) that you can search very quickly as opposed to the diabetes guidelines which are several hundred pages {I-5} Paper-based (N = 1) I don’t want paper-based {FG2-P2}