Local clinical pathways: from 'good ideas' to 'practicality' for general practitioners

INTRODUCTION: There has been increased interest in the utility of clinical pathways by primary health care in New Zealand, although evaluation of their use has been limited. AIM: To identify barriers and facilitators for the use of clinical pathways in one health region. METHODS: Interviews with 15 general practitioners in the Western Bay of Plenty. A qualitative thematic analysis was undertaken, informed by the Diffusion of Innovation Framework. RESULTS: Four themes were identified: learning to use the pathways, persuasion and decision to use, implementation and sustainability. Barriers to using the pathways included time pressure; scepticism; difficulty in portraying patients' clinical picture within a set pathway; technical difficulties and lack of support in obtaining knowledge; and practical implementation of the pathways in daily work. Facilitators included endorsement by opinion leaders; pathways directing workup and treatment stepwise towards referral; centralised information with resources available in the consultation; and reported increased acceptance of referrals by secondary care if pathways were used. DISCUSSION: The development and implementation of health care initiatives requires an understanding of the local context. Knowledge about the specific, locally appreciated barriers and facilitators can inform future health-care developments. The Diffusion of Innovation Framework offers a practical model to understand effective implementation.