Exploring Clinical Pathways in Primary Care: An Inquiry into Italian General Practitioners through Focus Group Research.



Clinical governance is an essential aspect of primary care. In Monza Brianza (ASLMB), Italy, the Local Health Authority implemented clinical pathways on an experimental basis since 2005 to enhance the care of patients suffering from chronic diseases by general practitioners (GPs). The objective was to introduce clinical governance in primary care, increase the participation of GPs in their patients' care and improve satisfaction levels of both patients and professionals. Initially, 12% of the 763 GPs employed by ASLMB participated in the experiment in 2005-2006, which increased to 15-20% in 2007-2008.


To assess the perception of the GPs who participated in the experiment, 24 GPs were purposively sampled and randomly divided into two groups. In 2008, these GPs were asked to attend focus groups (FGs). The purpose of these FGs was to evaluate their experiences of the experiment. The FGs were audio-recorded, and the dialogues were transcribed and analyzed thematically, using the Interpretative Phenomenological Approach.


Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity.


Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.


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