[Implementation of clinical guidelines in general practice. The effect of journal audit and continuing education for the treatment of cardiovascular risk factors in patients with and without type 2 diabetes].

INTRODUCTION: The objectives of this study were, first, to describe the status of implementation of clinical guidelines for prevention of ischaemic heart disease in subjects with arterial hypertension, dyslipidemia and type 2 diabetes, but without known cardiovascular disease, and, second, to describe the changes in treatment following journal audit and education of GPs.

MATERIAL AND METHODS: 230 general practitioners (GPs) were invited to include 20 consecutive at-risk patients. One year after the first data collection of 3,555 patients by 182 GPs, a new set of 3,023 patients was collected by 170 GPs from a new patient population. In the period between the two surveys, the GPs were educated through workshops and an international meeting focusing on cardiovascular risk factor treatment.

RESULTS: The quality of the care being delivered was suboptimal. Approximately 15-40% of the patients had obtained the treatment goals for hypertension, dyslipidemia and type 2 diabetes. Some improvement was demonstrated following education and journal audit, but a gap still exists between the recommended treatment and the treatment patients actually receive.

CONCLUSION: There is a need for improvement in the implementation of clinical guidelines focusing on diabetes and cardiovascular disease.