Challenges to best practice: why are guidelines not implemented?

The National Cholesterol Education Programm(NECP) and the European Atherosc lerosis Society (EAS) have each published detailed guidelines for achieving recommended low-density lipoprotein cholesterol (LDL-C) levels for patient s at risk of coronary heart disease (CHD) and those with established diseas e. However, surveys such as EUROASPIRE have shown that treatment guidelines are not always used and-that many coronary patients are not reaching their LDL-C goals. There are several reasons that may explain this current under-use of treatm ent guidelines. For example, physicians may not follow them because of diff iculties in extrapolating clinical trial data to complex patients in practi ce, lack of involvement in the consensus process, or lack of opportunity to evaluate and adapt guidelines to local practice. Mixed messages arising fr om multiple sets of guidelines may deter physicians from using them. In add ition, there are several barriers to the implementation of good CHD treatme nt and prevention guidelines, over which individual physicians have little control. These include cultural barriers and a number of economic issues. It is important to understand why current treatment guidelines in the preve ntion of CHD are not being followed so that these issues can-be resolved. T reatment guidelines must be simple and consistent to prevent confusion, and barriers such as cost, which prevent physicians from prescribing effective treatments, must be addressed. Revised recommendations for the prevention of CHD in clinical practice have recently been developed by the EAS, the European Society of Cardiology, th e European Society of Hypertension, the European Society of General Practic e/Family Medicine and the. International Society of Behavioural Medicine. T hese guidelines are simple, consistent with scientific evidence and are fis cally responsible.