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International Journal for Quality in Health Care 14:509-518 (2002)
© 2002 International Society for Quality in Health Care

Paper

Specialists’ expectations regarding joint treatment guidelines for primary and secondary care

W. N. KASJE1,2, P. DENIG1,2 and F. M. HAAIJER-RUSKAMP1,2

1Department of Clinical Pharmacology, Northern Centre for Health Care
2Groningen University Institute for Drug Exploration, University of Groningen, The Netherlands

Objective. To identify factors that may hinder or facilitate specialists’ use of joint treatment guidelines for primary and secondary care.

Design. Qualitative study using focus group discussions based on a topic guide with open-ended questions.

Main outcome measures. Themes identified by two researchers that specify the specialists’ views on the use and implementation of treatment guidelines in general, and transmural guidelines in particular.

Setting. Departments of Cardiology and Internal Medicine in three Dutch hospitals.

Study participants. Ten general internists, 11 cardiologists, and six gastroenterologists participating in seven group discussions.

Results. Specialists did not perceive the treatment guidelines as useful for their own field of expertise, but expected that joint guidelines might improve integration between primary and secondary care. Furthermore, the guidelines could be useful for areas outside their expertise, for specialists in training, and for general practitioners. Concerns were expressed regarding their content and development process. In addition, specialists feared negative consequences, such as loss of autonomy, extra administrative workload, and organizational and financial barriers such as loss of industry-sponsored research and conferences.

Conclusion. Specialists are not very motivated to use the guidelines themselves. This is a major obstacle that should be addressed in an implementation programme. Furthermore, negative outcomes at the organizational and financial levels must be minimized or compensated for. A joint implementation programme seems worthwhile, making use of the advantage seen by specialists in making agreements with general practitioners.

Keywords: changing physician behaviour, clinical practice, practice guidelines, integrated care, physician’s attitudes, qualitative research


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