German ambulatory care physicians' perspectives on clinical guidelines – a national survey

BACKGROUND: There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM) The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. METHODS: Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi(2 )test was used to investigate distribution of two or more categorical variables. RESULTS: Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. CONCLUSION: Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs

Die Veränderung der Lebensqualität von Patienten mit obstruktivem Schlafapnoe-Syndrom unter CPAP-Therapie

$\bf Studienziel:$ Untersuchung des Einflusses von CPAP auf LQ von OSAS Patienten und des Einflusses der Nutzungsdauer des CPAP-Geräts auf LQ. $\bf Methodik:$ 85 Patienten (66 compliante, 19 nicht-compliante) mit OSAS werden zu Therapiebeginn und nach 1 Jahr zu LQ mit Nottingham Health Profile (NHP), Visueller Analogskala LQ (VAS) und Spitzer-Index befragt. Ein Vergleich der zwei Gruppen erfolgte. $\bf Ergebnis:$ Die LQ der Therapieanwender verbessert sich unter CPAP-Therapie signifikant in NHP und VAS, die der Therapieabbrecher nicht. Weder Nutzungsdauer des CPAP-Geräts noch Schwere des OSAS korrelieren mit LQ. $\bf Zusammenfassung:$ CPAP-Therapie verbessert die LQ von OSAS Patienten im Langzeitverlauf signifikant. Krankheitsspezifische Instrumente sind notwendig, um einen genaueren Zusammenhang zwischen CPAP-Therapie und LQ zu zeigen und das Zusammenspiel von Compliance und LQ zu objektivieren