Leitlinienorientierung in der hausärztlichen Versorgung – Befunde einer quantitativen und qualitativen Studienreihe zur Leitliniennutzung von niedergelassenen Allgemeinmediziner*innen

Evidence-based clinical guidelines are intended to make patient care more effective and to ensure that it is based on current scientific findings. General practitioners, who encounter a wide range of symptoms and clinical pictures in everyday practice, can benefit particularly from clinical guidelines. In German-speaking countries, there is currently a lack of reliable studies on how general practitioners view clinical guidelines from their perspective and how they experience the use of these instruments in the care process.

The aim of this exploratory series of studies was to gain a comprehensive picture of general practitioners’ views and experiences with regard to evidence-based clinical guidelines (S2e/S3 guidelines). The question of implementability and the physicians’ expectations of clinical guidelines were also of particular importance.

Between February and July 2022, all 12,993 general practitioners in North Rhine-Westphalia and Rhineland-Palatinate were interviewed using an online survey, with 4538 physicians taking part (response rate: 35%). In addition to the descriptive evaluation, a t-test with independent samples and a factor analysis were used. Moreover, 20 general practitioners were interviewed using qualitative semi-standardized interviews.

General practitioners see clear added value for care in clinical guidelines (e.g., evidence orientation, uniform diagnostic and treatment standards, reduction of incorrect care). Around two thirds of the physicians who actively use guidelines themselves have experienced positive effects on the quality of care and an improvement in their own skills. However, the implementation of clinical guidelines poses widespread problems for general practitioners, since the specifications often collide with practice routines and economic requirements. Where possible and rational, guidelines can be expanded to include more emphasis on non-drug-based alternatives. The component of delegation to members of the practice staff could also be expanded to relieve the burden on general practitioners.

In order for general practitioners to be more willing to follow evidence-based clinical guidelines, these should be practical, economical, and legally compliant. At the same time, medical freedom of action should be emphasized. The recommendations given in the guidelines should highlight more options for delegation.