van der Weijden T, Hutten J B, Brandenburg B J, Grol R P, van der Velden K
Centre for Quality of Care Research, University of Maastricht, The Netherlands.
Scand J Prim Health Care. 1994 Dec;12(4):281-8. doi: 10.3109/02813439409029254.
To examine cholesterol diagnosis and treatment by Dutch general practitioners (GPs) in the period before publication of national guidelines, in order to develop implementation strategies based on discrepancies found between daily practice and the guidelines.
Data of the 'Dutch National Survey of General Practice', in which GPs were involved in extensive consultation registration, were used. Patients were included for analysis if serum cholesterol, or the ICPC-code lipid metabolism disorder, or cholesterol-lowering treatment was registered.
General practice.
161 GPs, 177 practice-nurses.
Reasons for consultation, diagnoses, therapy, inter-doctor variation.
The main discrepancies between daily practice and the guidelines concerned indications for cholesterol measurement, repeated measurements to diagnose hypercholesterolaemia, and attention for diet advice. A remarkable inter-doctor variation in diagnosis, and less so in treatment, was also found.
The inter-doctor variation justifies the publication of the standard guidelines. Implementation strategies should aim at indications for cholesterol testing, repeating measurements for diagnosis, and advice on diet.
在国家指南发布之前，考察荷兰全科医生对胆固醇的诊断和治疗情况，以便根据日常实践与指南之间发现的差异制定实施策略。
采用“荷兰全科医疗全国调查”的数据，其中全科医生参与了广泛的会诊登记。如果登记了血清胆固醇、国际初级保健分类（ICPC）编码的脂质代谢紊乱或降胆固醇治疗，则将患者纳入分析。
全科医疗。
161名全科医生，177名执业护士。
会诊原因、诊断、治疗、医生间差异。
日常实践与指南之间的主要差异涉及胆固醇测量的指征、诊断高胆固醇血症的重复测量以及饮食建议的关注。还发现医生间在诊断方面存在显著差异，而在治疗方面差异较小。
医生间的差异证明了标准指南发布的合理性。实施策略应针对胆固醇检测的指征、重复测量以进行诊断以及饮食建议。
