The self-perceived role of general practitioners in care of patients with cardiovascular diseases. A survey in Central and Eastern European countries following health care reforms

Abstract

Background: The aims of this study were: (1) to explore differences in primary care physicians' self-perception of care provided for patients with cardiovascular diseases in Central and Eastern European countries; (2) to analyse the relationship between physicians' characteristics and self-perceived care.

Methods: A cross-sectional survey of 3000 primary care physicians randomly chosen from relevant registers in nine European countries was performed. Data were collected via anonymous questionnaire dedicated to care provided for patients with cardiovascular diseases.

Results: Direct access to the basic additional tests essential in cardiovascular disease management was declared to be high. Considerable differences were found in the access to examinations requiring ultrasound techniques (p<0.01). For global risk assessment 68.2% of physicians reported the use of the Systematic Coronary Risk Evaluation and 33.8% the Framingham model (p<0.01). Nearly all physicians felt responsible for pharmacotherapy of hypertension but there were major differences related to treatment of diabetes mellitus type 2 and dyslipidemia. Relatively low numbers of family physicians/general practitioners would be prepared to start lipid lowering therapy with fibrates (12.5% in Estonia and 92.8% in Poland; p<0.01). Only a weak relationship was found between characteristics of physicians and their self-perceived performance.

Conclusions: Primary care physicians from Central and Eastern Europe accept their responsibility for care of patients with cardiovascular diseases and declare good access to basic additional examinations. Differences in treatment of diabetes mellitus and dyslipidemia cannot be explained by the characteristics of physicians and the explanation probably lies with other factors such as organisational or financial ones.