Table 3.
Barrier to change | Interventions selected | Barrier adequately addressed? |
Loss of income with telephone consultations | Increased fee for telephone consultations | Yes, although we are not sure that the increase in fee was large enough |
Changing routines from ordinary visits to increased use of telephone consultations is a complex process | Plan and support for the practices to discuss existing routines and make changes, patient information | No. We did not have the means to actively support the practices discussing and changing their routines |
Fear of overlooking serious disease with telephone consultations, delegating responsibility to GP assistants, and not using lab tests | Computer-based decision support with structured questions including check list with warning symptoms | Partially. Most practices needed more active support in using the computer-based system with confidence |
Patients want and expect testing for urinary tract infection and sore throat and treatment for sore throat | Patient information, both in written format and computer-based, linked to the decision support system | Partially, this intervention depends on GPs giving patient information. Supplying leaflets is not enough |
Not enough time to read information about the project and study the guidelines | Brief versions of guidelines, computer-based reminders, incentives for participation | Partially. We were not able to help practices prioritise time for studying and discussion |
*The barriers are similar for urinary tract infection and sore throat, if not specifically stated.