Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners

Table 2 Perceived barriers* to the implementation of key recommendations from selected guidelines

Perceived barriers	Key recommendations (N = 56)		Clinical guidelines (N = 12)
	N	%	N	%
Knowledge	26	46	10	83
Lack of knowledge	26	46	10	83
Lack of awareness/familiarity	26	46	10	83
Attitude	51	91	12	100
Lack of agreement with guideline recommendation	38	68	12	100
Interpretation/lack of evidence**	13	23	9	75
Lack of applicability	32	57	12	100
Lack of self-efficacy	11	20	8	67
Lack of outcome expectancy	17	30	10	83
Inertia of previous practice/lack of motivation	15	27	8	67
Behaviour	46	82	12	100
Patient factors	22	40	11	92
Patients preferences/demands	14	25	9	75
Patients ability/behaviour**	11	20	8	67
Guideline recommendation factors	24	43	11	92
Unclear/ambiguous**	18	32	11	92
Incomplete/not up to date**	8	14	4	33
Not easy to use/too complex**	3	5	3	25
Environmental factors	29	52	12	100
Lack of time/time pressure	7	13	5	42
Lack of resources/materials	7	13	5	42
Organisational constraints	20	36	11	92
Lack of reimbursement	2	4	2	17

* Barriers were classified according to the framework of Cabana et al. (1999) with some additional types of sub-barriers (**)

ISSN: 1748-5908