Changing Primary Care Doctors' Conceptions - A Qualitative Approach to Evaluating an Intervention.

Abstract

Objective: To describe conceptions of the management of hyperlipidaemia and assess changes in conceptions after an educational intervention.- Setting and subjects: Primary care in Sweden. Twenty doctors at community health centres.- Methods: Within an educational experiment evaluating the effects of 'group detailing' by community pharmacists at 67 health centres, a selected sample of doctors were interviewed on two occasions, one and a half year apart, regarding their views on atherosclerotic cardiovascular disease and hyperlipidaemia. Half of the doctors had, in between the interviews, participated in four educational group sessions, where information was presented and discussed regarding the national recommendations on the management of hyperlipidaemia. Applying a phenomenographic approach, the variation of conceptions was described regarding six domains: general attitude to cardiovascular disease, risk factors, prevention of ischaemic heart disease, role of blood lipids, treatment of hyperlipidaemia, and screening for hypercholesterolaemia.- Outcome measures: Descriptions of categories of conceptions and changes of conceptions to ones in line with the treatment guidelines for individual doctors and for the two groups of doctors.- Results: There was a variation of conceptions in all six domains in both groups of doctors. The doctors' conceptions in the intervention group changed significantly to ones in line with the treatment recommendations (p < 0.01), which was not the case in the control group. A significant number of doctors in the intervention group changed at least one of the six conceptions to ones in concordance with the recommendations (p = 0.011). Although doctors in the control group also changed conceptions, this change was not statistically significant.- Conclusions: The doctors' conceptions changed significantly after 'group detailing' on management of hyperlipidaemia. Qualitative changes of conceptions may be used as outcome measures when evaluating the impact of an information activity directed at health care professionals.