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[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.