In other words, the currently used surrogate parameters are also, or simply, measures of guideline compliance that the specialist teams introduce to the individual centres on the basis of structural and process quality, and multidisciplinarity.
This result indicates that our measure of guideline compliance increased significantly after program implementation.
We included trials that reported both a measure of guideline adherence and at least one clinical outcome.
However, international data show that GPs overestimate their adherence to guidelines, suggesting that self-reported adherence might not correlate well with actual prescribing behaviour and should not be used as the sole measure of guideline adherence [ 29].
Existing evidence suggests that the sensitivity of reported screening is very high across age categories, but it is also sparse, suggesting the need for additional research on this question to help validate this measure of guideline compliance [ 42].
Clearly, it cannot be concluded from a doctor's reporting of a clinical practice in her/his setting, that this practice is used all the time for every patient who needs it: self-reports mainly provide information regarding clinicians' knowledge of guideline recommendations, but they are subject to bias – overestimation – and should not be used as the sole measure of guideline adherence [ 27].
Our secondary objective is to assess the impact of the intervention on other CVD risk factors (total cholesterol, High Density Lipoprotein (HDL) cholesterol, blood pressure, Body Mass Index (BMI)), behavioural risk factors (exercise, smoking and diet) and process of care measures (achievement of guideline based standards for monitoring, and intensification of therapy).
Using literature-based estimates, we have applied these measures to guidelines for pharmacological methods of secondary prevention of myocardial infarction (MI) for a hypothetical general practice population of 10,000.
Measures for reinforcement of Guidelines were considered essential to provide encouragement for use and to ensure sustained benefit.
While PTH adherence is likely a good measure of CKD guideline adherence, the impact on clinical outcomes is unknown.
