title: Physicians' knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases.
abstract: BACKGROUND
  Guidelines are one of the means by which health care organizations try to improve health care and lower its cost. Studies have shown, however, that guidelines are still not being adequately implemented. In this exploratory study, we examine the link between physicians' knowledge of and compliance with guidelines: specifically, guidelines for the treatment of three cardiovascular diseases (arterial hypertension, heart failure and chronic coronary heart disease [CHD]) in primary care.
  
  
  METHODS
  We assessed primary care physicians' knowledge of the guidelines with a representative postal survey, using a questionnaire about the treatment of cardiovascular diseases (2500 questionnaires sent). We assessed the responding physicians' compliance with the guidelines by analyzing patient data from a sample of 30 of them for various indicators of compliance. Of these 30 physicians, 15 met our operational criteria for adequate knowledge of the guidelines, and 15 did not.
  
  
  RESULTS
  437 (40%) of the physicians knew the guidelines adequately. Physicians answered questions about chronic CHD in accordance with the guidelines more often than they did questions about arterial hypertension (74% versus 11%). Our exploratory analysis of guideline compliance revealed that physicians who knew the guidelines adequately performed no differently than physicians who did not with respect to 12 of the 16 compliance indicators. As for the remaining 4 compliance indicators, it turned out, surprisingly, that physicians who did not know the guidelines adequately performed significantly better than those who did.
  
  
  CONCLUSIONS
  These preliminary findings imply that physicians' knowledge of guidelines does not in itself lead to better guideline implementation. Further studies are needed to address this important issue.
authors.affiliation: IMVR – Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft der Humanwissenschaftlichen, Fakultät und der Medizinischen Fakultät der Universität zu Köln, Köln, Germany. Ute.Karbach@uk-koeln.de
authors.forename: Ute
authors.initials: U
authors.lastname: Karbach
authors.forename: Ingrid
authors.initials: I
authors.lastname: Schubert
authors.forename: Jens
authors.initials: J
authors.lastname: Hagemeister
authors.forename: Nicole
authors.initials: N
authors.lastname: Ernstmann
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Hans-Wilhelm
authors.initials: HW
authors.lastname: Höpp
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*