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Applying clinical guidelines in general practice: a qualitative study of potential complications

Overview of attention for article published in BMC Family Practice, July 2016
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (74th percentile)

Mentioned by

twitter
9 tweeters

Citations

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23 Dimensions

Readers on

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65 Mendeley
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Title
Applying clinical guidelines in general practice: a qualitative study of potential complications
Published in
BMC Family Practice, July 2016
DOI 10.1186/s12875-016-0490-3
Pubmed ID
Authors

Bjarne Austad, Irene Hetlevik, Bente Prytz Mjølstad, Anne-Sofie Helvik

Abstract

Clinical guidelines for single diseases often pose problems in general practice work with multimorbid patients. However, little research focuses on how general practice is affected by the demand to follow multiple guidelines. This study explored Norwegian general practitioners' (GPs') experiences with and reflections upon the consequences for general practice of applying multiple guidelines. Qualitative focus group study carried out in Mid-Norway. The study involved a purposeful sample of 25 Norwegian GPs from four pre-existing groups. Interviews were audio-recorded, transcribed and analyzed using systematic text condensation, i.e. applying a phenomenological approach. The GPs' responses clustered around two major topics: 1) Complications for the GPs of applying multiple guidelines; and, 2) Complications for their patients when GPs apply multiple guidelines. For the GPs, applying multiple guidelines created a highly problematic situation as they felt obliged to implement guidelines that were not suited to their patients: too often, the map and the terrain did not match. They also experienced greater insecurity regarding their own practice which, they admitted, resulted in an increased tendency to practice 'defensive medicine'. For their patients, the GPs experienced that applying multiple guidelines increased the risk of polypharmacy, excessive non-pharmacological recommendations, a tendency toward medicalization and, for some, a reduction in quality of life. The GPs experienced negative consequences when obliged to apply a variety of single disease guidelines to multimorbid patients, including increased risk of polypharmacy and overtreatment. We believe patient-centered care and the GPs' courage to non-comply when necessary may aid in reducing these risks. Health care authorities and guideline developers need to be aware of the potential negative effects of applying a single disease focus in general practice, where multimorbidity is highly prevalent.

Twitter Demographics

The data shown below were collected from the profiles of 9 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 65 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 2 3%
Spain 1 2%
Unknown 62 95%

Demographic breakdown

Readers by professional status Count As %
Student > Master 10 15%
Researcher 8 12%
Other 8 12%
Student > Bachelor 7 11%
Student > Ph. D. Student 5 8%
Other 11 17%
Unknown 16 25%
Readers by discipline Count As %
Medicine and Dentistry 25 38%
Pharmacology, Toxicology and Pharmaceutical Science 4 6%
Social Sciences 4 6%
Agricultural and Biological Sciences 2 3%
Biochemistry, Genetics and Molecular Biology 2 3%
Other 7 11%
Unknown 21 32%

Attention Score in Context

This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 January 2017.
All research outputs
#3,746,705
of 15,741,154 outputs
Outputs from BMC Family Practice
#464
of 1,596 outputs
Outputs of similar age
#67,209
of 266,432 outputs
Outputs of similar age from BMC Family Practice
#1
of 1 outputs
Altmetric has tracked 15,741,154 research outputs across all sources so far. Compared to these this one has done well and is in the 76th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,596 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.6. This one has gotten more attention than average, scoring higher than 70% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 266,432 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 74% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them