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Primary care practitioners based everyday practice on internalised tacit guidelines derived through social interactions with trusted colleagues

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Q How do primary care practitioners (general practitioners [GPs] and practice nurses) use evidence in their day to day decisions about patient management?


Ethnographic study.


A rural teaching practice (“Lawndale”) and a university based inner city practice (“Urbchester”) in the UK.


9 physicians, 3 nurses, a phlebotomist, and associated administrative staff from the Lawndale practice.


In the Lawndale practice, data were collected on use of information in clinician-patient interactions in 10 GP surgeries, 4 nurse clinics, 9 practice meetings, and various other meetings using non-participant observation, semistructured formal and informal interviews, and documentary review of guidelines or practice protocols. Observations and interviews were either tape recorded or recorded in field notes. Thematic analysis led to derivation of a theoretical model of the ways in which evidence and information became built into clinical or policy decisions. The model’s transferability and credibility were assessed using data collected from observations and …

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  • For correspondence: A le May, University of Southampton, Southampton, UK.

  • Source of funding: former Department of Health South East Regional Office R&D Directorate.