Awareness and Barriers to Guideline Adherence: Slovenian Family Physicians Survey and Qualitative Feedback.

Abstract

Introduction: Clinical practice guidelines are essential for standardizing care, yet adherence in primary care remains inconsistent globally. The aim of this study was to assess the use of clinical guidelines by family physicians in Slovenia for diagnosing and managing common conditions, to explore factors influencing guideline awareness and decision-making, and to identify barriers to adherence.

Methods: A nationwide cross-sectional study surveyed family medicine specialists and trainees across public and private practices in rural and urban Slovenia. Participants completed an online questionnaire to evaluate their awareness of professional guidelines (27 guidelines made by Slovenian healthcare professionals). Furthermore, they were tested on guideline-aligned decisions (five clinical vignettes). The last question in the survey was an open-ended question on the main obstacles associated with the use of clinical guidelines.

Results: Out of 660 physicians surveyed, only 57 respondents completed the questionnaire in full (8.6% response rate). Guideline awareness varied significantly (average 60.8%), with higher knowledge of guidelines for relatively common conditions (e.g., 96% for arterial hypertension versus 12% for polycythemia vera). Correct clinical decisions according to guidelines were made in 65.2% of cases (lowest average scores for osteoporosis, 57.9%, highest for dyspepsia, 69.7%). Minimal statistically significant differences emerged between family medicine specialists and trainees (decisions regarding peripheral arterial occlusive disease, p = 0.024), public or private practice types (decisions regarding low urinary tract symptoms, p = 0.037), and urban or rural practice settings (decisions regarding chronic obstructive pulmonary disease, p = 0.008 and p = 0.016). Answers to the open-ended question were divided into six categories according to the content: organizational limitations (lack of time and availability of guidelines), limitations related to the characteristics and quality of guidelines, team members' lack of knowledge or work based on experience, complex patients, non-cooperative patients, and financial limitations.

Conclusion: On average, family physicians in Slovenia make clinical decisions according to guidelines in 65.2% of cases. Organizational constraints, notably workload and time pressures, are the leading obstacles to guideline adherence. Interventions such as extended consultation times, centralized digital guideline repositories, and annual update seminars are recommended. Our study highlights the need for broader research to validate strategies for enhancing guideline implementation and adherence in primary care.