title: Inefficacy of different strategies to improve guideline awareness - 5-year follow-up of the hypertension evaluation project (HEP).
abstract: BACKGROUND
  In spite of numerous guidelines for evidence based diagnostic and therapy adequate knowledge of current recommendations is disappointingly low. In the Hypertension Evaluation Project (HEP I) we showed that awareness of national hypertension guidelines under German practitioners was less than 25% in the year 2000. This indicates the need for efficient strategies to relevantly improve guideline awareness.
  
  
  METHODS
  To asses different tools for amending guideline knowledge we used three strategies (guideline in print, interactive guideline, expert seminars) to train 8325 randomised physicians, who had participated in the HEP I trial. Guideline knowledge of the trained physicians was again tested with the HEP questionnaire and compared to a control group of HEP I physicians.
  
  
  RESULTS
  The return rate of questionnaires was 57.9% without a significant distinction between the groups. Overall guideline awareness was still low but remarkably improved compared to the results of HEP I (37.1% vs. 23.7%, p < 0.0001). There was no difference between the trained physicians and the control group (35.8% and 35.9% vs. 39.7%, p = n.s.).
  
  
  CONCLUSIONS
  We investigated the influence of different strategies to improve guideline awareness among German physicians. None of our interventions (guideline in print, interactive guideline, expert seminars) brought a notable benefit compared to control group. However, overall knowledge of guideline contents increased from 23.7% to 37.1% over five years. Therefore, other probably multimodal interventions are necessary to significantly improve guideline awareness beyond spontaneous advancement.
  
  
  BACKGROUND
  ISRCTN53383289.
authors.affiliation: Department of Medicine III, University of Cologne, D-50924 Cologne, Germany. jens.hagemeister@uk-koeln.de
authors.forename: Jens
authors.initials: J
authors.lastname: Hagemeister
authors.forename: Christian A
authors.initials: CA
authors.lastname: Schneider
authors.forename: Holger
authors.initials: H
authors.lastname: Diedrichs
authors.forename: Diana
authors.initials: D
authors.lastname: Mebus
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Gernot
authors.initials: G
authors.lastname: Wassmer
authors.forename: Hans W
authors.initials: HW
authors.lastname: Höpp