Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices

Objective. To evaluate the feasibility and implementation needs of a choles terol guideline by assessing the effectiveness of simple dissemination as w ell as extensive implementation of this guideline on actual performance of general practitioners (GPs). Design. Randomized controlled trial. Setting and subjects. Thirty-two Dutch GPs in 20 general practices, 3950 pa tient records. Interventions. Guideline dissemination to all 32 GPs, and a 5-month program me for improvement in the intervention group. This programme was developed after barriers to working according to the guideline had been investigated, and consisted of group education, desktop supportive materials, feedback o n performance, and face-to-face instruction on location. Main outcome measures. The outcome parameters were defined as quality of se lective case finding and quality of diagnostic procedures, and were measure d by chart audit. Results. The quality of selective case finding, especially the targeting of cholesterol testing to those with positive cardiovascular risk profiles, d id not improve following intervention. Performance of the procedure necessa ry to diagnose hypercholesterolaemia even deteriorated. The quantity of cho lesterol testing increased in both groups, but this was probably explained by the increased availability of desktop cholesterol analysers. Conclusions. Neither simple dissemination nor an intensive programme for im provement had measurable impact on actual performance on working according to the cholesterol guideline. Both the validity and the opinion about feasi bility of the guideline in daily practice deserve more attention during gui deline development.