DÄ internationalArchive28-29/2011Quality of Treatment Is Almost Identical
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The authors sought to establish an association between (guideline related) knowledge of general practitioners and how competently they treated their patients. The conclusion, as befits the subject matter, could have been: insufficiently trained GPs (with inadequate knowledge of guidelines) achieve inadequate results with their treatment. The article, however, showed a different result: the quality of treatment was almost identical in both groups of physicians, whether a doctor had adequate or inadequate knowledge of the guidelines.

In spite of this finding, the conclusion was: “Increased efforts should be made—as has already happened in some integrated care projects—to implement guideline recommendations as in-process control variables in standardized software.”

The study was intended to provide proof that such software corridors are needed, but it didn’t do so. And another, similarly inconsistent, result was not even included among the key messages: with respect to the four coronary heart disease (CHD)–related indicators (indicator-guided analysis), the doctors who had demonstrated inadequate knowledge in the test were actually superior in terms of the therapeutic criteria to their colleagues with better CME certifications. The most important indicator was patients’ blood pressure, which was controlled better by doctors without adequate knowledge of guidelines than by those with certified knowledge. This is particularly notable because as far as the guideline test for blood pressure was concerned, only 11% of doctors had adequate knowledge of guidelines. The 89% of GPs whose knowledge of guidelines was inadequate had achieved better control of blood pressure in their patients.

The important components of the study’s results were ignored and linked to the insistence on changing practices’ IT systems. This cannot logically be deduced from the results, and the question is what the authors’ motives might be.

DOI: 10.3238/arztebl.2011.0490a

Klaus Lischka

Villingendorf, Germany

lilamed@gmx.de

Conflict of interest statement
The author declares that no conflict of interest exists.

1.
Karbach U, Schubert I, Hagemeister J, Ernstmann N, Pfaff H, Höpp HW: Physicians’ knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases. Dtsch Arztebl Int 2011; 108(5): 61–9. VOLLTEXT
1.Karbach U, Schubert I, Hagemeister J, Ernstmann N, Pfaff H, Höpp HW: Physicians’ knowledge of and compliance with guidelines: an exploratory study in cardiovascular diseases. Dtsch Arztebl Int 2011; 108(5): 61–9. VOLLTEXT