[Are there any differences in guideline adherence to pharmacotherapy of heart failure between individual GP practices and Medical Care Centres (MCCs)?].
BACKGROUND
Chronic heart failure is one of the most important cardiovascular diseases. Patients with this common disease are primarily treated by general practitioners (GPs). Previous research showed deficits in drug therapy. Ambulatory care in Germany is changing; new structures for medical care (Medical Care Centres) have been registered since 2003. It was of interest to evaluate medical procedures of these new structures and compare them to the one applied in traditional single practices. Aim of this study was to investigate compliance with guidelines regarding drug therapy of chronic heart failure performed by GPs working in two different outpatient settings.


METHODS
A prospective observational study was conducted. Over a period of eight months medical pharmacotherapy in individual practices and a Medical Care Centre (MCC) was compared. To ensure comparability in both settings GPs treating randomly selected patients were asked to recruit patients with heart failure, encode their NYHA class and conduct echocardiography to verify the diagnosis.


RESULTS
241 heart failure patients were enrolled by general practitioners (137 in individual practices and 104 in MCCs). GPs working in MCCs performed more diagnostic echocardiographies than physicians in individual practices. ACE inhibitors/sartans, beta blockers and diuretics were prescribed less often than recommended in the guideline.


CONCLUSIONS
The hypothesis of insufficient adherence to guideline recommendations for pharmacotherapy of ambulatory heart failure patients was confirmed. However, the prescribing behaviour for pharmacotherapy of heart failure among the physicians in Berlin was better than among their European colleagues. There were only minor differences in drug prescription between the 11 GPs from single practices and the 12 GPs working in an MCC.
Dini
Lorena
L
Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin. Lorena.Dini@charite.de
Heintze
Christoph
C
Welke
Justus
J
Stein
Tanja
T
Rufer
Veronika
V
Braun
Vittoria
V
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000553:Ambulatory Care / Q000592:standards*; D000554:Ambulatory Care Facilities / Q000592:standards*; D001604:Berlin; D003971:Diastole / Q000187:drug effects; D004232:Diuretics / Q000627:therapeutic use; D004358:Drug Therapy / Q000592:standards*; D004452:Echocardiography / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013599:Systole / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists