Physicians' Knowledge of and Compliance with Guidelines An Exploratory Study in Cardiovascular Diseases

Background: Guidelines are one of the means by which health care organiz- ations try to improve health care and lower its cost. Studies have shown, how- ever, that guidelines are still not being adequately implemented. In this ex- ploratory study, we examine the link between physi-cians' knowledge of and compliance with guidelines: specifically, guidelines for the treatment of three cardiovascular diseases (arterial hypertension, heart failure and chronic coron- ary heart disease [CHD]) in primary care. Methods: We assessed primary care physicians' knowledge of the guide-lines with a representative postal survey, using a questionnaire about the treatment of cardiovascular diseases (2500 questionnaires sent). We assessed the re- sponding 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 operation-al criteria for adequate knowledge of the guidelines, and 15 did not. Results: 437 (40%) of the physicians knew the guidelines adequately. Phys- icians answered questions about chronic CHD in accordance with the guide- lines more often than they did questions about arterial hypertension (74% ver- sus 11%). Our exploratory analysis of guideline compliance revealed that phys- icians who knew the guidelines adequately performed no differently than phys- icians who did not with respect to 12 of the 16 compliance indicators. As for the remaining 4 compliance indicators, it turned out, surprisingly, that phys- icians who did not know the guidelines adequately performed significantly better than those who did. Conclusion: These preliminary findings imply that physicians' know- ledge of guidelines does not in itself lead to better guideline implementation. Further studies are needed to address this important issue.