[The use of guidelines in the primary care management of hypertension and diabetes].
OBJECTIVE
The paper examines to what degree German primary care physicians know and work along the rules established in guidelines for arterial hypertension and diabetes mellitus.


METHODS
HYDRA is a 2-stage cross-sectional point prevalence study with 1912 participating primary care settings throughout Germany including 45,125 patients. A pre-study questionnaire to assess doctors practice patterns was used. Subsequently doctors completed a structured clinical appraisal with a diagnostic workup and characterization of the current treatments provided. All patients filled out a questionnaire.


RESULTS
Pre-study results show that only every second primary care physician manages the patients according to established guidelines. Further, physicians estimated their own work as problematic and not always successful. Guideline-oriented doctors were more likely to report hypertension and diabetes treatment patterns that also match guideline's recommendations.


CONCLUSIONS
The study shows a considerable degree of dissatisfaction with the quality of their work among primary care physicians. Guideline-oriented doctors however reveal more frequently formally adequate management characteristics. This encouraging aspect suggests the need of more successful implementation of medical guidelines in order to achieve improved evidence-based medicine and better patient-oriented health care.
Wagner
Nicole
N
Institut für Klinische Pharmakologie und Forschungsverbund Public Health Sachsen und Sachsen-Anhalt e.V., TU Dresden. Public.Health@mailbox.tu-dresden.de
Pittrow
David
D
Kirch
Wilhelm
W
Küpper
Beate
B
Krause
Petra
P
Höfler
Michael
M
Bramlage
Peter
P
Wittchen
Hans-Ulrich
HU
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011785:Quality Assurance, Health Care
D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents