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Cross-sectional Analysis of Guidelines on Cardiovascular Disease Risk Factors: Going to Meet the Inconsistencies

Department of Medical Informatics, ErasmusMC University Medical Centre Rotterdam, PO Box 1738, 3000DR Rotterdam, the Netherlandsj.vanwyk{at}erasmusmc.nl

Marc A. M. van Wijk, MD, PhD

Peter W. Moorman, MD, PhD

Johan van der Lei, MD, PhD

Department of Medical Informatics, ErasmusMC University Medical Centre Rotterdam, the Netherlands.

Objective. To identify the possible inconsistency of statements among the practice guidelines of the Dutch College of General Practitioners (DCGP) with respect to the management of risk factors for cardiovascular disease (CVD). Methods. Cross-sectional analysis of all electronically available DCGP practice guidelines dealing with CVD risk factor management for statement inconsistencies and reference inconsistencies.Results. Six DCGP guidelines out of 74 electronically available guidelines had either CVD or CVD risk factors as the subject of the guideline. Eight statement inconsistencies-were found, and for each statement inconsistency, a reference inconsistency was present.Conclusions. Given that inconsistencies were found, the authors recommend that organizations that maintain a set of guidelines update the guidelines using a cross-sectional analysis of guidelines. Inconsistencies between guidelines might lead to physicians being unintentionally noncompliant with guideline recommendations.

Key Words: practice guidelines • cardiovascular disease • decision support

References

• Fuster V, Gotto AM, Libby P, Loscalzo J, McGill HC. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 1. Pathogenesis of coronary disease: the biologic role of risk factors. J Am Coll Cardiol. 1996;27:964–976.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD. Cholesterol reduction yields clinical benefit: impact of statin trials. Circulation. 1998;97:946–952.[Abstract/Free Full Text]
• Jacobson TA. "The lower the better" in hypercholesterolemia therapy: a reliable clinical guideline? Ann Intern Med. 2000;133:549–554.[Abstract/Free Full Text]
• WongET, LincolnTL. Ready! Fire!... Aim! An inquiryintolaboratory test ordering. JAMA. 1983;250:2510–2513.[Abstract/Free Full Text]
• Kelly JT. Role of clinical practice guidelines and clinical profiling in facilitating optimal laboratory use. Clin Chem. 1995;41:1234–1236.[Abstract/Free Full Text]
• Field MJ, Lohr KN. Institute of Medicine. Clinical Practice Guidelines: Directions for anew program. Washington (DC): National Academy Press; 1990.
• NHG Standaarden, Vol. 2002. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden.
• Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, EnkinMW, Hannah WJ. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989;321:1306–1311.[Abstract]
• Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993;342:1317–1322.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• van der Weijden T, Grol RP, Knottnerus JA. Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices. Int J Qual Health Care. 1999;11:131–137.[Abstract/Free Full Text]
• DowieR. Areview of research in theUnitedKingdom to evaluate the implementation of clinical guidelines in general practice. Fam Pract. 1998;15:462–470.[Abstract/Free Full Text]
• Weingarten S. Translating practice guidelines into patient care: guidelines at the bedside. Chest. 2000;118:4S–7S.[Abstract/Free Full Text]
• Hermens RP, Hak E, Hulscher ME, Braspenning JC, Grol RP. Adherence to guidelines on cervical cancer screening in general practice: programme elements of successful implementation. Br J Gen Pract. 2001;51:897–903.[Web of Science][Medline] [Order article via Infotrieve]
• van Wijk MA, van der Lei J, Mosseveld M, Bohnen AM, van Bemmel JH. Assessment of decision support for blood test ordering in primary care. Arandomized trial. AnnInternMed. 2001;134:274–281.[Abstract/Free Full Text]
• Chin HL, Wallace P. Embedding guidelines into direct physician order entry: simple methods, powerful results. Proc AMIA Symp. 1999:221–225.
• Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computerbased clinical decision support systems on physician performance andpatient outcomes: a systematic review. JAMA. 1998;280:1339–1346.[Abstract/Free Full Text]
• vanWijkMA, BohnenAM, van der Lei J. Analysis of the practice guidelines of the Dutch College of General Practitioners with respect to the use of blood tests. J Am Med Inform Assoc. 1999;6:322–331.[Abstract/Free Full Text]
• Weed LL. Medical records that guide and teach. N Engl J Med. 1968;278:593–600.[Web of Science][Medline] [Order article via Infotrieve]
• Weed LL. Medical records that guide and teach. N Engl J Med. 1968;278:652–657.[Web of Science][Medline] [Order article via Infotrieve]
• Rutten FH, BohnenAM, Hufman P, et al. NHG-StandaardAngina Pectoris, NHG. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden/M43/std.htm.
• Kaiser V, Hooi JD, Stoffers HEJH, Boutens EJ, Van der Laan JR. NHG-Standaard Perifeer arterieelvaatlijden, NHG. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden/M13/std.htm.
• Van Binsbergen JJ, Gelpke JEH, Van Bentum STB, et al. NHGStandaard TIA, NHG. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden/M45/std.htm.
• Thomas S, Van der Weijden T, Van Drenth BB, Haverkort AFM, Hooi JD, Van der Laan JR. NHG-Standaard Cholesterol, NHG. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden/M20/std.htm.
• Rutten GEHM, Verhoeven S, Heine RJ, et al. NHG-Standaard DiabetesMellitus Type 2, NHG. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden/M01/std.htm.
• Walma EP, Grundmeijer HGLM, Thomas S, Prins A, Van den Hoogen JPH, Van der Laan JR. NHG-Standaard Hypertensie, NHG. Retrieved 1 September 2002 from http://nhg.artsennet.nl/standaarden/M17/std.htm.
• Thomas S. Standard setting in the Netherlands: impact of the humanfactor on guidelinedevelopment. Br J Gen Pract. 1994;44:242–243.[Web of Science][Medline] [Order article via Infotrieve]
• Wang D, PelegM, Tu SW, Shortliffe EH, Greenes RA. Representation of clinical practice guidelines for computer-based implementations. Medinfo. 2001;10:285–289.
• Peleg M, Tu S, Bury J, et al. Comparing computer-interpretable guideline models: a case-study approach. J Am Med Inform Assoc. 2003;10:52–68.[Abstract/Free Full Text]
• Eccles M, McColl E, Steen N, et al. Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial. BMJ. 2002;325:941-941.[Abstract/Free Full Text]
• Rousseau N, McColl E, Newton J, Grimshaw J, EcclesM. Practice based, longitudinal, qualitative interview study of computerised evidence based guidelines in primary care. BMJ. 2003;326:314-314.[Free Full Text]
• Shiffman RN, Shekelle P, Overhage JM, Slutsky J, Grimshaw J, Deshpande AM. Standardized reporting of clinical practice guidelines: a proposal from the Conference on Guideline Standardization. Ann Intern Med. 2003;139:493–498.[Abstract/Free Full Text]

Medical Decision Making, Vol. 26, No. 1, 57-62 (2006)
DOI: 10.1177/0272989X05284104


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