Guidelines or mindlines? A qualitative study exploring what knowledge informs psychiatrists decisions about antipsychotic prescribing

Background: Gabbay and le May (2004) argue that successful implementation of research evidence requires a better understanding of clinical "sense-making" and how different knowledge is used in practice. Aims: To explore the psychiatrists decision-making about prescribing of antipsychotic medication and to identify potential barriers to the implementation of guidelines for the pharmacological management of schizophrenia. Method: Qualitative study using semi-structured interviews with 22 consultant psychiatrists. Results: We identified four types of knowledge: acquired: interpreted; individual experience; and contextual. These were grouped within a personal or a scientific perspective, and located at the level of the "self" or "others". Each of these sources of knowledge informs "mindlines" the personalized and tacit sense-making - on which prescribing decisions were based. Conclusions: This study indicates that guidelines are only one, component of the knowledge consultant psychiatrists might use when making decisions about the pharmacological management of patients with schizophrenia. The presence of competing and complex sources of knowledge and the use of mindlines could explain why the simple dissemination of guidelines will not change prescribing practice. Declaration of interest: The research on which this paper was based was funded by NHS South West Executive R&D Programme Development Grant (PDG/09/05.99/Harrison).