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Cholesterol management in Dutch general practice. A comparison with national guidelines. Dutch College of General
T van der Weijden1, J B Hutten, B J Brandenburg
1Centre for Quality of Care Research, University of Maastricht, The Netherlands.
Objective:
To examine cholesterol diagnosis and treatment by Dutch general practitioners (GPs) in the period before publication of national guidelines, in order to develop implementation strategies based on discrepancies found between daily practice and the guidelines.
Design:
Data of the 'Dutch National Survey of General Practice', in which GPs were involved in extensive consultation registration, were used. Patients were included for analysis if serum cholesterol, or the ICPC-code lipid metabolism disorder, or cholesterol-lowering treatment was registered.
Setting:
General practice.
Participants:
161 GPs, 177 practice-nurses.
Outcome Measures:
Reasons for consultation, diagnoses, therapy, inter-doctor variation.
Results:
The main discrepancies between daily practice and the guidelines concerned indications for cholesterol measurement, repeated measurements to diagnose hypercholesterolaemia, and attention for diet advice. A remarkable inter-doctor variation in diagnosis, and less so in treatment, was also found.
Conclusion:
The inter-doctor variation justifies the publication of the standard guidelines. Implementation strategies should aim at indications for cholesterol testing, repeating measurements for diagnosis, and advice on diet.