Knowledge and perception of guidelines and secondary prevention of coronary heart disease among general practitioners and internists. Results from a physician survey in Germany.
OBJECTIVE
This study investigated knowledge and perception of guidelines in secondary prevention of coronary heart disease and the impact of guideline knowledge on treatment practices in coronary patients among primary care physicians.


METHODS
A representative questionnaire survey was performed in 2002-2003 among all 1023 general practitioners and office-based internists in the Region of Münster, Germany. The survey instrument contained questions on knowledge and attitudes toward guidelines, risk factors and treatment practices in secondary prevention of coronary heart disease.


RESULTS
In total, 681 (66.6%) physicians participated. Seventy percent of physicians reported knowledge of at least one guideline. Participants expressed mainly positive attitudes toward guidelines but also reported important barriers to their implementation such as lack of reimbursement. Only 63 and 32%, respectively, reported to start antihypertensive and lipid-lowering treatment according to guidelines. Physicians reporting guideline knowledge were more likely to initiate lipid-lowering treatment of elevated low-density lipoprotein (LDL)-cholesterol [odds ratio (OR) 2.3; 95% confidence interval (CI) 1.5-3.5], to intensively advise overweight patients (OR 1.5; 95% CI 1.0-2.5), to make use of nicotine replacement therapy or cessation courses in smoking patients (OR 1.7; 95% CI 1.2-2.4), and to comply with an overall measure of guideline adherence (OR 1.8; 95% CI 1.1-2.8).


CONCLUSIONS
In this study, guideline knowledge led to improved cardiovascular risk factor treatment among GPs and internists. Many physicians, however, do not treat coronary patients according to evidence-based guidelines. Further dissemination of guidelines and educational efforts are essential to improve secondary prevention of coronary heart disease.
Heidrich
Jan
J
Institute of Epidemiology and Social Medicine, University of Münster, Germany. heidricj@uni-muenster.de
Behrens
Thomas
T
Raspe
Friederike
F
Keil
Ulrich
U
D000328:Adult; D001291:Attitude of Health Personnel; D003327:Coronary Disease / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000523:psychology*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires