The therapeutic gap--compliance with medication and guidelines

Area of Science:

• Cardiology
• General Practice
• Public Health

Background:

• Hospitals and cardiologists heavily influence general practice prescribing habits.
• Physicians in primary care consider hospital recommendations crucial for new drug information.
• Current coronary heart disease (CHD) prevention shows suboptimal evidence-based management of risk factors like hypercholesterolaemia and hypertension in both primary and secondary care.

Purpose of the Study:

• To highlight the impact of hospital recommendations and cardiologist influence on primary care prescribing.
• To emphasize the need for improved evidence-based management of CHD risk factors.
• To underscore the role of cardiologists in enhancing CHD risk factor management within primary care.

Main Methods:

• Review of current surveys on CHD prevention strategies.
• Analysis of the impact of hospital and specialist recommendations on general practice.
• Examination of European guidelines for secondary prevention in established CHD.

Main Results:

• Hospital recommendations are a key information source for primary care physicians regarding new drugs.
• Evidence-based management of hypercholesterolaemia and hypertension in CHD prevention is currently inadequate.
• Lowered cholesterol thresholds are recommended based on studies like 4S, CARE, and LIPID.

Conclusions:

• There is a critical need for hospital quality assurance to adopt and implement evidence-based guidelines.
• Cardiologists possess the potential to significantly improve the management of CHD risk factors in primary care settings.
• Collaborative efforts between secondary and primary care are essential for effective CHD prevention and risk factor management.