%0 Journal Article
%T The role of guidelines and the patient's life-style in GPs' management of hypercholesterolaemia
%A Lars Backlund
%A Ylva Sk£¿n¨¦r
%A Henry Montgomery
%A Johan Bring
%A Lars-Erik Strender
%J BMC Family Practice
%D 2004
%I BioMed Central
%R 10.1186/1471-2296-5-3
%X Twenty GPs were exposed to six case vignettes presented on a computer. In the course of six screens, successively more information was added to the case. The doctors were instructed to think aloud while processing the cases (Think-Aloud Protocols) and finally to decide for or against drug treatment. After the six cases they were asked to describe how they usually reason when they meet patients with high cholesterol values (Free-Report Protocols). The two sets of protocols were coded for cause-effect relations that were supposed to reflect the doctors' knowledge of guidelines. The Think-Aloud Protocols were also searched for reasons for the decisions to prescribe or not to prescribe.According to the protocols, the GPs were well aware of the importance of previous coronary heart disease and diabetes in their decisions. On the other hand, only a few doctors mentioned other arterio-sclerotic diseases like stroke and peripheral artery disease as variables affecting their decisions. There were several instances when the doctors' decisions apparently deviated from their knowledge of the guidelines. The arguments for the decisions in these cases often concerned aspects of the patient's life-style like smoking or overweight- either as risk-increasing factors or as alternative strategies for intervention.Coding verbal protocols for knowledge and for decision arguments seems to be a valuable tool for increasing our understanding of how guidelines are used in the on treatment of hypercholesterolaemia. By analysing arguments for treatment decisions it was often possible to understand why departures from the guidelines were made. While the need for decision support is obvious, the current guidelines may be too simple in some respects.The decision to recommend or not to recommend drug treatment for individuals with high cholesterol values should depend on an evaluation of the individual's risk for future cardiovascular disease, primarily coronary heart disease (CHD). The European
%U http://www.biomedcentral.com/1471-2296/5/3