General practitioners’ experiences with multiple clinical guidelines: A qualitative study from Norway

Background: It is well known that general practitioners (GPs) often do not adhere to clinical guidelines, but reasons for this seem complex and difficult to understand. Limited research focuses on the total amount of clinical guidelines as they appear in general practice. The aim of this study was to get in-depth information by exploring Norwegian GPs’ experiences and reflections on the use of multiple clinical guidelines in their daily work. Methods: A qualitative focus group study based on a purposeful sample of 25 Norwegian GPs within four preexisting groups. The GPs’ work experience varied from recent graduates up to 35 (mean 9.6) years. The interviews were analysed with systematic text condensation which is a phenomenological approach. Results: 1) The GPs considered clinical guidelines to be necessary and to provide quality and safety in their clinical practice. 2) However, they found it difficult to adhere to them due to guideline overload, guidelines that were inaccessible and overly large, and because of a mismatch between guidelines and patients’ needs. Adherence was especially difficult in multimorbid patients where several guidelines were expected to be applied at the same time. 3) The discrepancy between judging guidelines as necessary but difficult to adhere to, created dilemmas for the practitioners. The GPs handled these by using their clinical judgement and by putting a greater focus on the patients’ complaints and quality of life than on adhering to guidelines. Conclusions: The GPs provided compelling reasons for low adherence to clinical guidelines despite considering them to be necessary. This challenge the idea that quality of care in general practice is largely synonymous with adherence to guidelines for single diseases.