Adherence by primary care physicians to guidelines for the clinical management of dyslipidemia

Geva Vashitz, Joachim Meyer, Yisrael Parmet, Yaakov Henkin, Roni Peleg, Nicky Liebermann, Harel Gilutz

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is a wide treatment gap between evidencebased guidelines and their implementation in primary care. Objective: To evaluate the extent to which physicians "literally" follow guidelines for secondary prevention of dyslipidemia and the extent to which they practice "substitute" therapeutic measures. Methods: We performed a post hoc analysis of data collected in a prospective cluster randomized trial. The participants were 130 primary care physicians treating 7745 patients requiring secondary prevention of dyslipidemia. The outcome measure was physician literal adherence or substitute adherence. We used logistic regressions to evaluate the effect of various clinical situations on literal and substitute adherence. Results: Literal adherence was modest for ordering a lipoprotein profile (35.1%) and for pharmacotherapy initiations (26.0%), but rather poor for drug up-titrations (16.1%) and for referrals for specialist consultation (3.8%). In contrast, many physicians opted for substitute adherence for uptitrations (75.9%) and referrals for consultation (78.7%). Physicians tended to follow the guidelines literally in simple clinical situations (such as the need for lipid screening) but to use substitute measures in more complex cases (when dose up-titration or metabolic consultation was required). Most substitute actions were less intense than the actions recommended by the guidelines. Conclusions: Physicians often do not blindly follow guidelines, but rather evaluate their adequacy for a particular patient and adjust the treatment according to their assessment. We suggest that clinical management be evaluated in a broader sense than strict guideline adherence, which may underestimate physicians' efforts.

Original languageEnglish
Pages (from-to)657-662
Number of pages6
JournalIsrael Medical Association Journal
Volume13
Issue number11
StatePublished - Nov 2011
Externally publishedYes

Keywords

  • Adherence
  • Atherosclerosis
  • Coronary artery disease
  • Guidelines
  • Pharmacotherapy
  • Primary care
  • Statins

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