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Health professionals often fail to follow guidelines
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9-13-99 Ann Arbor, Mich. Medical tests and treatments recommended by leading healthcare organizations are often ignored by care providers, according to a recent study by the Medstat Group. The findings are significant because clinical guidelines are intended to reduce or avoid the need for more serious and costly interventions later on. The study examined 33 clinical practice guidelines and compared them with the actual care received by patients with nine diseases: asthma, breast cancer, congestive heart failure, diabetes, hypertension, ischemic heart disease, lower back pain, otitis media, and peptic ulcer. "While we might not expect 100 percent of patients to receive the care recommended by the industry's leading clinical organizations, we most certainly expect most patients to receive it," said Louis H. Diamond, MD, vice president and medical director of The Medstat Group. In a sampling of the study released by the company, only 40 percent of 3,949 heart failure patients had an echocardiography test within three months of the initial diagnosis, despite the recommendations of the Agency for Health Care Policy and Research. Only 27 percent of 6,404 patients with asthma were prescribed an inhaled anti-inflammatory drug to control their condition, as recommended by the National Heart, Lung, and Blood Institute. Only 29 percent of 15,893 patients with diabetes received an annual eye exam and only 46 percent had their cholesterol tested annually, as the American Diabetes Foundation recommends. Results from the rest of the study were similarly disheartening, according to Medstat spokesperson Andrée Joyaux. "It's apparent we need to find alternative ways to get the word out about the best patient care guidelines," said Diana Schmidt, MPH, coordinator of the National Heart, Lung, and Blood Institute's national asthma education and prevention program. One strategy the institute is pursuing, said Schmidt, is the "case-study" approach, in which physicians are presented with a hypothetical patient and discuss symptoms, possible diagnoses, treatment, and management options based on current guidelines.
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