Barriers to working according to cholesterol guidelines: A randomized controlled trial on implementation of national guidelines in 20 general practices

Abstract

Background: the objective was to test the feasibility of cholesterol guidelines for Dutch general practitioners (GPs). Knowledge and favourable attitudes are fundamental to the adoption of these guidelines and need to be optimized for the successful implementation of the guidelines. The effect of a programme designed to improve these basic requirements was assessed and the barriers to change were investigated. Methods: the cholesterol guidelines were distributed to 32 GPs in 20 general practices. The study was conducted as a randomized controlled trial with a six month Intervention period. The programme for improvement consisted of group education, feedback on performance and face-to-face instruction on location. Results: the GPs increased their knowledge of the guidelines significantly after the educational session, but their score decreased to a lower level than the mean score of the control GPs at the follow-up. The level of agreement with the guidelines was already rather high at the baseline and remained comparable for both groups at the follow-up. The GPs' opinion of the feasibility of the guidelines, in contrast, was rather low at the baseline and remained low at the follow-up. Important barriers to change were the complexity of the guideline algorithm, the amount of time needed for this type of care, the difficulty in performing selective case finding and guidance of diet therapy. Conclusions: an intensive programme for improvement had hardly any impact on the basic requirements for adherence to the cholesterol guidelines. Both the validity of the guidelines and the opinion about the feasibility of the guidelines deserve more attention during the development of guidelines.