[Inadequate reimbursement and the patients themselves may inhibit the implementation of guidelines. Evaluation of the venous leg ulcer guideline of the German Society of Phlebology (DGP) in general and phlebology practices].
OBJECTIVE
The S3-guideline for diagnosis and treatment of venous leg ulcers published by the German Society for Phlebology (DGP) in 2006 was tested for its acceptance and practicability in outpatient care delivered by general practitioners (GPs) and phlebologists. Barriers to the implementation of the guideline's recommendations in regular health care were identified.


METHODS
Qualitative research using focus groups and interviews by telephone; systematic content analysis of records and transcripts by two independent researchers.


RESULTS
Altogether, GPs and phlebologists gave a positive evaluation of the guideline, but it also became clear that it does not form the basis of their everyday work practice. Factors inhibiting the application of the guideline included the insufficient reimbursement systems and the patients' compliance, but these factors were weighed differently between the two groups. Evidence-based performance seems to play a minor role with regard to patients suffering from leg ulcers in daily practice.


CONCLUSIONS
Barriers of implementation as well as detailed suggestions by the users will help to revise and to adapt the guideline to the needs of both users and patients.
Wollny
Anja
A
Abteilung für Allgemeinmedizin, Universitätsklinikum Düsseldorf. Anja.Wollny@med.uni-duesseldorf.de
Rieger
Monika A
MA
Wilm
Stefan
S
D019317:Evidence-Based Medicine / Q000592:standards*; D005858:Germany; D006801:Humans; D018962:Phlebotomy / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D012051:Reimbursement Mechanisms; D012955:Societies, Medical; D014647:Varicose Ulcer / Q000191:economics* / Q000628:therapy*