Box 5.

Views about the guideline

Content of the asthma and angina guidelines

“I'm very happy with the content of the guidelines, and that is as good as expected” (General practitioner, interview study)

“The information in it is sound” (General practitioner, trial practice, feedback)

“I have to say I don't think I was doing an awful lot outside the guidelines to begin with anyway, so I think it was confirming my, my initial thoughts anyway” (General practitioner, interview study)

“We sort of know that to be honest, so it's not necessarily that useful. I think it's not telling us an awful lot that we don't already know” (General practitioner, interview study)

Barriers

“If a patient sits before you and says, ‘I feel a lot better after I’ve had my nebuliser, I feel as though I've got the dose and I'm less wheezy,' that's a subjective thing which you can't, you can't say, ‘no you don’t,' because that person is the person who's experienced it” (General practitioner, interview study)

“If you actually read the cardiology referral indications it's just about everyone (laugh). The system just couldn't stand it you know” (General practitioner, interview study)

“One of the problems that I have with evidence based medicine is that sometimes you go down certain lines because the evidence is best for certain things, but it may be that the evidence is only best for certain things because they are older and they've been around longer and the evidence is more robust, but because they have been around longer they may well not be the best. Because that's what they said at the [training] day—the evidence is there for verapamil, it isn't there for the other stuff, but it may not be there for other stuff because people haven't done it yet” (General practitioner, interview study)

General views

“Guidelines are there to be helpful, but . . . I'd say all GPs not just my partners are cynical about guidelines because you get guidelines for everything, and you get them till they're coming out your ears, to the point where you stick them in file and you think I'm not going to read them because you'll spend, you'll spend hours and hours each week I guess updating yourself on guidelines for this, guidelines for that” (General practitioner, interview study)

“I'm even using them to show the patient to say ‘I’m sorry but these are the guidelines that I've got to follow' ” (Nurse, interview study)

“Guidelines are good when you face difficult management problems” (General practitioner, interview study)