title: Achievement of guideline-defined treatment goals in primary care: the German Coronary Risk Management (CoRiMa) study.
abstract: OBJECTIVE
  The success in achieving treatment goals for cardiovascular risk factors in primary care is largely unknown. Therefore, the goals of this study were (i) to assess whether routinely collected practice data can be used to evaluate treatment in primary care, (ii) to compare current treatment with goals of published guidelines, and (iii) to calculate future risk for cardiovascular events using these real-life data.
  
  
  RESULTS
  In 110 physician offices in Germany, data from the patient management systems of all patients seen between January 1998 and June 2005 were extracted and analysed (715 644) with current guidelines used for reference. Of those patents, 284 096 (40% of all patients analysed) had one of the following diseases: 157 101 (55% of 284 096) had hypertension, 83 005 (29%) diabetes, 64 205 (23%) coronary artery disease (CAD), 174 787 (62%) hyperlipidaemia, and 136 360 (48%) had more than one of the listed diagnoses. During the last visit, treatment goals were achieved for total and LDL cholesterol in 9 and 29%, respectively, for blood pressure in 28%, and for HbA1c in 36%. Low achievement of treatment goals was also seen in patients with CAD or diabetes. Using the Framingham risk model and the SCORE Deutschland risk charts, 20 and 22% of patients had a high 10-year risk for a primary cardiovascular event and a fatal cardiovascular event, respectively. Achieving treatment goals for all risk factors would significantly reduce the number of high-risk patients.
  
  
  CONCLUSIONS
  (i) Routinely collected practice data can be used to evaluate quality of care; (ii) 40% of patients in primary care have cardiovascular disease or diabetes; (iii) even in high-risk patients, the majority does not achieve treatment goals; and (iv) achieving the treatment goals would reduce the proportion of high-risk patients from 20 to <5%.
authors.affiliation: Division of Cardiology, Zentralklinik Bad Berka, Robert Koch Allee 9, Bad Berka, Germany. c.geller.kar@zentralklinik-bad-berka.de
authors.forename: Johann Christoph
authors.initials: JC
authors.lastname: Geller
authors.forename: Sven
authors.initials: S
authors.lastname: Cassens
authors.forename: Mathias
authors.initials: M
authors.lastname: Brosz
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keil
authors.forename: Johannes
authors.initials: J
authors.lastname: Bernarding
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kropf
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Bierwirth
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lippmann-Grob
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schultheiss
authors.forename: Klaus
authors.initials: K
authors.lastname: Schlüter
authors.forename: Klaus
authors.initials: K
authors.lastname: Pels
mesh_terms: D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000628:therapy*; D004812:Epidemiologic Methods; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000458:organization & administration / Q000592:standards; D006801:Humans; D006949:Hyperlipidemias / Q000401:mortality / Q000628:therapy*; D006973:Hypertension / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011787:Quality of Health Care / Q000592:standards