Adherence to the Dutch general practitioner anemia guideline a retrospective cohort study

Background: Anemia is a common problem in general practice and often indicates underlying disease. For this reason an anemia guideline was developed by the Dutch College of General Practitioners (DCGP). Purpose: To investigate the adherence to the DCGP-anemia guideline for patients with new diagnosed anemia by general practitioners (GPs) before a cooperation of 63 GPs and a hospital laboratory was implemented. Material and methods: We retrospectively evaluated all laboratory tests of patients (women > 50 years and men ≥ 18 years) with new diagnosed anemia by 63 GPs in a two-year time period (2004-2005). Results: In 1342 men and women a new anemia was detected, of whom 131 patients (10 %) displayed a microcytic anemia, 1103 patients (82 %) a normoyctic and 65 patients (5 %) a macrocytic anemia. Execution of the DCGP-anemia guideline led to a laboratory cause of anemia in 190 patients (14.2 %), of whom 75 patients (5.6 %) with iron deficiency anemia (IDA) and 104 patients (7.7 %) with anemia of chronic disease (ACD). Of the 1152 undiagnosed patients (85.8 %) 1126 patients (83.9 %) lacked one or more laboratory parameters necessary for the DCGP-anemia guideline. In the 1234 patients with micro- or normocytic anemia ferritin, a critical laboratory parameter, was determined in only 396 patients (32.1 %). Factors significantly attributing to the request of a ferritin determination were lower hemoglobin, lower MCV, higher creatinine and male gender (p< 0.05). Conclusion: In general practice the DCGP-anemia guideline is followed only in a minority of patients, possibly leaving many causes of anemia undetermined.