Deficits in the implementation of medical guidelines in practice
21.06.2023 11:00
In many cases, it takes a very long time for evidence-based treatment recommendations from medical guidelines to actually reach practice and improve patient care across the board. The supply report presented today by the AOK Scientific Institute (WIdO) shows this using selected examples.
The Working Group of Scientific Medical Societies also sees a great need for action to improve the implementation of medical guidelines in practice.
“Our assessment of the implementation of guidelines in practice is very mixed,” says Christian Günster, head of the quality and healthcare research department at WIdO. The evaluations based on AOK routine data show that patients after a heart attack usually receive medications specified in the guidelines, such as statins or blood thinners. But there are also clear differences between the genders: “Women are less cared for than men. They are significantly less likely to receive the indicated invasive therapy procedures. For older women aged 80 and over, the treatment rate is almost ten percent lower than for men of the same age,” says Günster.
Too frequent use of risky medications for restless legs syndrome
According to the care report, there are also clear deficits in the implementation of therapy recommendations in the treatment of restless legs syndrome: “In the current guidelines, treatment with the drug levodopa is no longer recommended due to high risks. Our analysis shows that around a quarter of the diagnosed patients still receive long-term therapy with this drug. “30 percent of this group were treated with it for longer than two years,” says Günster. It is possible that many patients also engage in “doctor hopping” to obtain the drug. “There is still a lot to be done here to achieve drug therapy in line with guidelines,” emphasizes Günster.
The care report also contains examples in which new guideline recommendations took effect relatively quickly. Since 2016, there has been a negative recommendation for control coronary angiography after expansion of the coronary arteries with a balloon catheter (PCI). Routine diagnostic cardiac catheterization is no longer recommended unless it is expected to have a therapeutic consequence. “Here the recommendation has apparently led to a change of course. Since the publication of the new recommendations, there has been a significant decrease in the number of control coronary angiographies in question,” emphasizes Günster.