Analysis of Dutch general practice guidelines for inconsistencies with respect to the management of cardiovascular disease risk factors

Presenting guidelines relating to cardiovascular disease (CVD) in a clinical decision support system (CDSS) is viewed as a mechanism for introducing evidence based practice in to daily practice. Analysis of guidelines on consistency is needed before constructing such a system. We analyzed 74 electronically available Dutch general practice guidelines for statement inconsistencies with respect to the management of CVD, and for each inconsistency, whether incomplete cross referencing existed between the guidelines. Results: Six of the 74 guidelines had either CVD or CVD risk factors as subject of the guideline, all adhering to a common structure corresponding to four sections reflecting distinctive clinical management stages, which correspond to the subjective, objective, assessment and plan stages of SOAP methodology for structured patient data recording. Ten statement inconsistencies were found and for each a reference inconsistency was present. Conclusions: In a CDSS, statement inconsistencies will lead to poor system functioning. With electronically published guidelines, guideline developers could link statements in guidelines, to comparable statements in previously issued guidelines, facilitating the review process with respect to inconsistencies in related guidelines, and consistent cross referencing. Furthermore, it could enable the updating of existing guidelines with new evidence. Despite the determined statement inconsistencies, the authors would be able to construct a CDSS based on the DCGP guidelines dealing with the management of CVD risk factors.

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