Background There is still a gap between what good quality CPGs recommend and real practice. For osteoarthritis, although best quality CPGs do not recommend SYSADOAS, a high degree of variability in prescription rates has been observed.

Objectives To explore the reasons that explains SYSADOAS prescription for osteoarthritis.

Methods A qualitative research was performed including one focus group to explore what General Practitioners (GPs) thought about this topic, and two in-depth interviews with specialised care. 8 GPs, one orthopaedic surgeon and one reumatologist participated. Focus group and interviews, previous consent recorded, were transcribed and analysed using MAXQDA software.

Results GPs were aware of the lack of evidence about SYSADOAS efficacy, but they did not know which CPGs they should trust in. Prescription was mainly initiated by specialists, but GPs admitted that they also started it, being the respect for their colleagues and patients’ pressure the main reasons. Specialists did not use CPGs on this issue, but partially admitted that SYSADOAS had no effect. For them, health care pressure, high ratio of patients and a rapid way to discharge them were the main reasons.

Discussion Clinician’s knowledge about CPGs and quality standards is scarce. The lack of communication among health care levels and the inadequate management of the disease are, among others, the reasons explaining SYSADOAS prescription.

Implications for Guideline Developers/Users Provide clinicians skills and tools to empower them about which is considered good evidence and how to critically appraise CPGs, and promote the communication between levels to improve patient management.