Barriers to Swiss guideline-recommended cholesterol management in general practice

Standard guidelines for the management of dyslipidaemia are often not followed in general practice. The reasons for guideline non-adherence are not known.

Charts of 1000 consecutive unselected patients of 20 general practitioners in northwestern Switzerland were reviewed. An independent committee of experienced study physicians checked the data and assessed the reasons for not measuring plasma cholesterol and for not treating dyslipidaemia as recommended by guidelines.

Complete data of 866 patients were studied. 29% of all patients qualified for secondary prevention. 6% had no additional cardiovascular risk factors (apart from cholesterol values), 24% had one and 41% had 2 or more additional cardio- vascular risk factors. Guidelines were followed in 44% of all cases and were not followed in 56%. In 37.5% of all cases we found diagnostic guideline non-adherence, and in 10% only treatment guideline non-adherence. 8.5% of all patients had both diagnostic and treatment non-adherence. The main reasons for diagnostic non-adherence were relevant comorbidity (45%) and GPs' belief that the risk did not require screening (42%). The main reasons for treatment non-adherence were GPs' belief that the risk did not require treatment (42%) and relevant comorbidity (38%).

More than half of all patients aged 35-80 years are not screened or treated according to current guidelines. The reasons are to an equal extent patient-related (relevant comorbidity) and physician-related (acceptance and knowledge of guidelines). These reasons should be considered when programmes to improve the quality of GPs' adherence to guidelines are implemented.