Evidence into practice: a theory based study of achieving national health targets in primary care

Authors

  • Susan Michie MPhil DPhil CPsychol FBPsS,

    Corresponding author
    1. Reader in Clinical Health Psychology, Centre for Outcomes Research and Effectiveness, Department of Psychology, University College London, London, UK
      Dr Susan Michie
      Centre for Outcomes Research and Effectiveness
      Department of Psychology
      University College London
      1-19 Torrington Place
      London WC1E 7HB
      UK
      E-mail: s.michie@ucl.ac.uk
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  • Jane Hendy PhD,

    1. Research Fellow, Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
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  • Jonathan Smith DPhil,

    1. Senior Lecturer in Psychology, School of Psychology, Birkbeck University of London, London, UK
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  • Fiona Adshead MSc FFPH

    1. Director of Public Health, Camden Primary Care Trust
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Dr Susan Michie
Centre for Outcomes Research and Effectiveness
Department of Psychology
University College London
1-19 Torrington Place
London WC1E 7HB
UK
E-mail: s.michie@ucl.ac.uk

Abstract

Rationale, aims and objectives  This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful.

Methods  Sixteen London GPs were interviewed, eight ‘high implementers’ (having met five or more of six CHD NSF milestones) and eight ‘low implementers’ (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA).

Results  There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones.

Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care.

Conclusions  This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care.

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