Table 6 Facilitators and barriers of guideline implementability as perceived by Family Physicians: DEVELOPMENT

Trustworthinesss (N = 13)

Guidelines from a trusted and credible source (N = 5)

● I need to see that the guideline has been endorsed by credible sources [FG1-P1 I trust guidelines developed by a central committee of experts that are recognized from across the country such as diabetes or hypertension – when I trust a guideline, it is easy to understand and commit to memory and refer back to it over and over again {I-1}

Pharmaceutical sponsored (N = 4)

● I will flip very quickly over to who sponsored it, and if there is a pharmaceutical company on it, then I tend to take it with a grain of salt. So, those are also called guidelines and sometimes it's hard to distinguish {I-6}

Include who developed the guideline and how (N = 1)

● It’s important to know who developed the guideline and how they developed it. {I-6}

General distrust of guidelines (N = 3)

● Just because something is a guideline, I don’t necessarily trust that it is not conflicted, so that’s a concern for me {I-1}

Development process (N = 12)

Developers should get input from family physicians (N = 1)

● Specialists writing the guidelines should probably get input from family physicians - for hypertension, it says use this medication because it's wonderful, but when you are facing the patient, they tell you that they can't afford it {FG4-P1}

Developers do not understand the nature of family practice (N = 2)

● They [guideline developers] should realize that an appointment is 10 minutes and you need to deal with an issue, prescribe the medication, and talk about the risks and side effects in that 10-minutes, and if you can't deal with all the issues in 10 minutes then the guideline is too cumbersome {FG4-P2}

Developers should write guidelines in simple “GP” language (N = 1)

● Put guidelines in simple “GP” language {FG2-P1}

Not written for target audience (N = 3)

● So I don't think they are clear as to exactly who they were writing for: for doctors in general or just for family doctors {FG1-P1}

Written by people not involved in primary care (N = 1)

● It’s written by people who are likely not involved in primary care. We need something that you can very quickly skim through, and they are not always created that way {FG1-P1}

Developers should perform a good literature review (N = 1)

● You want to feel that guideline developers have looked at all the information and did a good literature review. {I-6}

Developers do not use a systematic approach to develop guidelines (N = 1)

● I don't think guidelines are developed using a systematic approach, and it's a slow process {FG4-P1}

Developers do not agree on content of guidelines (N = 1)

● So, among specialists, I don’t think they agree on the guidelines anyway. Some specialists have different opinions than those in guidelines {FG2-P2}

Developers do not consider practicality and accessibility (N = 1)

● 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}