Abstract
Despite the wide availability of guidelines in primary care, adherence in practice is often suboptimal. The aim of this paper is to explore the gap between the availability of a wide range of guidelines and their limited uptake in clinical practice and to explore ways to bridge this gap. Methods: We reviewed the current literature on the implementation of guidelines in primary care to gain insight into the gap between theory and practice. Findings from two studies focusing on barriers to guideline adherence and interventions to improve it were used to illustrate the gap between theory and practice and to provide recommendations to bridge this gap. Results: The most perceived barriers to guideline adherence among general practitioners (GPs) across recommendations are lack of applicability and patient factors. To improve guideline adherence, GPs prefer small group interactive educational meetings and audit and feedback. In addition, recommendations in guidelines showed varying patterns of barriers as well as varying patterns of preferred interventions. Conclusions: The gap between theory and practice is determined by a wide range of general and recommendation specific barriers. Aside from these barriers, GPs’ preferences for interventions need to be taken into account when developing interventions to bridge the gap between theory and practice. Focusing on key recommendations and engaging the target group in identifying barriers and interventions seems to be a useful method. Promising tools for the future may be decision aids to support the flexible use of guidelines and to promote shared decision making.
