title: Barriers to improved dyslipidemia control: Delphi survey of a multidisciplinary panel.
abstract: OBJECTIVE
  To assess the barriers that make it difficult for the health care professionals (physicians, nurses and health care managers) to achieve a better control for dyslipidemia in Spain.
  
  
  METHODS
  The study has an observational design and was performed using the modified Delphi technique. One hundred and forty-nine panel members from medicine, nursing and health care management fields and from different Spanish regions were selected randomly and were invited to participate. Individual and anonymous opinions were asked by answering a 42-items questionnaire via e-mail (two rounds were done). Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the three groups (Kappa index and McNemar chi-square).
  
  
  RESULTS
  Response rate: 81%. The agreement index was 33.3 (95% CI: 18.9-47.7). Regarding the non-compliance with therapy, it improves with patient education degree in dyslipidemia, patient motivation, the agreement on decisions with the patient and with the use of cardiovascular risk measure and it gets worse with lack of information on the objectives to achieve. Clinical inertia improves with professional's motivation, cardiovascular risk calculation, training on objectives and the use of indicators and it gets worse with lack of treatment goals.
  
  
  CONCLUSIONS
  Different perceptions and attitudes between medicine, nursing and health care management were found. An agreement in interventions in non-compliance and clinical inertia to improve dyslipidemia control was reached.
authors.affiliation: Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, atencion.primaria@umh.es.
authors.forename: Concepción
authors.initials: C
authors.lastname: Carratala-Munuera
authors.affiliation: Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante.
authors.forename: Vicente F
authors.initials: VF
authors.lastname: Gil-Guillen
authors.affiliation: Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante.
authors.forename: Domingo
authors.initials: D
authors.lastname: Orozco-Beltran
authors.affiliation: Family Medicine, Manises Primary Health Care Center, Valencia Health Agency, Valencia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Maiques-Galan
authors.affiliation: Family Medicine, Sardoma Primary Health Care Center, Galician Health Service, Vigo.
authors.forename: Fernando
authors.initials: F
authors.lastname: Lago-Deibe
authors.affiliation: Family Medicine, Jazmin Primary Health Care Center, Madrid.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Lobos-Bejarano
authors.affiliation: Research Unit, Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona.
authors.forename: Carlos
authors.initials: C
authors.lastname: Brotons-Cuixart
authors.affiliation: Family Medicine, Fuensanta Clinical Management Unit, Reina Sofia Hospital, IMIBIC and Cordoba University, Cordoba and.
authors.forename: Enrique
authors.initials: E
authors.lastname: Martin-Rioboo
authors.affiliation: Family Medicine, La Calzada II Primary Health Care Center, Gijon, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alvarez-Guisasola
authors.affiliation: Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante.
authors.forename: Adriana
authors.initials: A
authors.lastname: Lopez-Pineda
mesh_terms: D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003697:Delphi Technique; D050171:Dyslipidemias / Q000628:therapy*; D034742:Electronic Mail; D006282:Health Personnel / Q000193:education*; D006801:Humans; D010349:Patient Compliance; D010353:Patient Education as Topic; D020399:Practice Management; D012307:Risk Factors; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Cardiovascular disease; Delphi technique; family practice; hyperlipidemias; practice management; risk factors.