Imperial College London

DrGevaGreenfield

Faculty of MedicineSchool of Public Health

Research Fellow in Public Health
 
 
 
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Contact

 

+44 (0)20 7594 8595g.greenfield Website

 
 
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Location

 

314Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Vashitz:2011,
author = {Vashitz, G and Meyer, J and Parmet, Y and Henkin, Y and Peleg, R and Liebermann, N and Gilutz, H},
journal = {Isr. Med. Assoc. J.},
pages = {657--662},
title = {Adherence by primary care physicians to guidelines for the clinical management of dyslipidemia},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22279697},
volume = {13},
year = {2011}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - BACKGROUND There is a wide treatment gap between evidence-based guidelines and their implementation in primary care. OBJECTIVE To evaluate the extent to which physicians "literally" follow guidelines for secondary prevention of dyslipidemia and the extent to which they practice "substitute" therapeutic measures. METHODS We performed a post hoc analysis of data collected in a prospective cluster randomized trial. The participants were 130 primary care physicians treating 7745 patients requiring secondary prevention of dyslipidemia. The outcome measure was physician literal adherence or substitute adherence. We used logistic regressions to evaluate the effect of various clinical situations on literal and substitute adherence. RESULTS Literal adherence was modest for ordering a lipoprotein profile (35.1%) and for pharmacotherapy initiations (26.0%), but rather poor for drug up-titrations (16.1%) and for referrals for specialist consultation (3.8%). In contrast, many physicians opted for substitute adherence for up-titrations (75.9%) and referrals for consultation (78.7%). Physicians tended to follow the guidelines literally in simple clinical situations (such as the need for lipid screening) but to use substitute measures in more complex cases (when dose up-titration or metabolic consultation was required). Most substitute actions were less intense than the actions recommended by the guidelines. CONCLUSIONS Physicians often do not blindly follow guidelines, but rather evaluate their adequacy for a particular patient and adjust the treatment according to their assessment. We suggest that clinical management be evaluated in a broader sense than strict guideline adherence, which may underestimate physicians' efforts.
AU - Vashitz,G
AU - Meyer,J
AU - Parmet,Y
AU - Henkin,Y
AU - Peleg,R
AU - Liebermann,N
AU - Gilutz,H
EP - 662
PY - 2011///
SN - 1565-1088
SP - 657
TI - Adherence by primary care physicians to guidelines for the clinical management of dyslipidemia
T2 - Isr. Med. Assoc. J.
UR - http://www.ncbi.nlm.nih.gov/pubmed/22279697
VL - 13
ER -