344 Adherence To Dutch Guidelines

Jozé Braspenning, Anne Marieke Schiere, Henk Mokkink, Richard Grol
Centre for Quality of Care Research
An important aspect of quality of care can be defined as performing according to the guidelines. To what extent do general practices adhere to the guidelines?
Method Adherence to the guidelines has been expressed in 139 indicators from 70 national guidelines. Data have been collected, a full year, in the period May 2000 until April 2002 in 104 general practices (195 general practitioners; 415,925 patients) by extracting information from electronic medical records (contacts, prescriptions, referrals). All the information had a diagnosis code. An electronic questionnaire and an instrument on practice organisation completed the data set. The practices and its population were national representative.
Results For 106 indicators acceptable data were found. Indicators on the prevalence showed that detection could be encouraged for hypertension, hypercholesterolaemia, heart failure, alcohol abuse, dementia, fear, and children with asthma, urine incontinence, hearing problems, and osteoporosis. Image techniques for diagnosing were requested according to the guidelines, but this was not true for laboratory tests. The prescription indicators showed that is was more common to follow the guidelines if they appealed on not prescribing certain medication than if they came up if strict advises. Big adherence was shown for the referrals under study. The indicators on preventive activities showed that small improvement is possible.
The indicators deliver reference figures on the performance in general practice. Partly, they can refer by themselves to the quality of care delivered and partly the variance among the result is referring to the quality of care in general practice.