Management of patients with angina pectoris by GPs: a study with standardized (simulated) patients in actual practice.

Abstract

Little is known about the management of patients with angina pectoris by GPs. The purpose of this study was to assess how a group of GPs managed a patient with angina pectoris complaints in a real-life practice setting during unbiased consultations with standardized patients. GPs were consulted during normal surgery hours by a standardized patient portraying a patient with angina pectoris. The setting was Trondheim, Norway. All 87 GPs in the city of Trondheim (Norway) were informed by letter about a study with standardized patients and invited to take part. They were asked to give consent to be visited during actual surgery hours by standardized patients. The date, number and content of the visits planned were not mentioned. They were not told that the study focused on angina pectoris. For budgetary reasons it was decided to ask 24 physicians to participate. The GPs were consulted during normal surgery hours by a standardized patient portraying a patient with angina pectoris. The patients reported on the consultations using a checklist based on guidelines for management of angina pectoris. Outcome measures were the content and number of actions undertaken from the guidelines. Twenty-eight GPs (32%) agreed to participate. Of these, 24 were selected and visited. One doctor detected the standardized patient. The results showed that the participating physicians met 76% of the guidelines used. However, the GPs ordered 31 different types of laboratory test (mean = 7.9, range = 1-18 per physician). In addition, the 23 consultations resulted in seven referrals (two for chest X-rays, four for an exercise test and one referral to a specialist in cardiology). Twenty-two of the 23 doctors made the correct diagnosis and informed the patient accordingly. When assessed in an unbiased situation in real practice, GPs performed well against a pre-set standard for management of angina pectoris patients. Much variation was found in the request for laboratory tests. These real-life practice data suggest that there is a need for discussing guidelines for effective ordering of laboratory tests in general practice.