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Table 7 Facilitators and barriers of guideline implementability as perceived by Family Physicians: PRACTICE ENVIRONMENT

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

Top facilitators (Number of utterances) Utterance example Top barriers (Number of utterances) Utterance example
Accessibility (N = 12)
  Should be accessible (N = 3) Accessibility of the information is a factor that will impact on implementability {I-9} Not accessible (N = 6) Guidelines are not accessible {FG1-P3}
If I have to look for it, it will not happen as easily {FG2-P2}
One thing I find difficult about using different guidelines is just finding them when I need them {Laughter} {I-8}
It has to be something that can be handy and accessible {I-5}
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}
Available at the point of care (POC) (N = 2) A useful guideline is one that is available at the POC - so that comes in either a convenient hard copy document that you can search very quickly as opposed to the diabetes guidelines which are several hundred pages. Osteoporosis has a little one-pager that was sent out with the journal {I-5}
One of the barriers is not realizing that the guidelines are available {I-2}
One of the big problems in terms of accessibility with guidelines, you’ve to find them, so are they there when you need them {I-1}
Timely access (N = 1) It should be timely in terms of my time and the time it takes to read it, and to have it so I can use it {I-10}
Implementation (N = 10)
  - - Not enough time to use guidelines (N = 8) I don't have time to read the whole guideline {I-4}
I don't have time, I'm, I am not seeing just hypertension patients, like the cardiologist so I don't have all the time to deal with all the details and all the facts, so guidelines should be thinking about our time {FG2-P2}
Too many guidelines (N = 4) There are so many of them [guidelines] and it's difficult to know which to follow because the easy ones you remember (e.g., Diabetes) because you know the ideal target;with hypertension, it tells you, this is my first choice, what should I do step by step, but I don’t think I will do that. {FG2-P2}
There are too many guidelines to keep abreast {I-2}
Lack of support to implement (N = 1) We don’t have you know, enough support to help you know, explain all the things that we are doing so that the outcome is better {I-9}
Resource implications of following guidelines (N = 1) One barrier is resources – I don’t think the evidence is there or the system is ready for every single male patient over the age of 50 year to get screened for prostate cancer (i.e., PSA test). I don’t think Urologists would know how much volume they would get if every single patient was screened for PSA. {I-5}