Patient- vs Physician-Reported Implementation of and Compliance to Anti-Osteoporotic Medication One Year after Sustained Fragility Fracture Abstract. We were interested why therapy recommendations made by specialists are often not followed by general practitioners (GPs) and patients. We evaluated systematic questionnaires comparing both, patient and GP statements (n = 151 each) with regard to the implementation of and compliance to specific therapy recommended by an osteologic specialist one year after an osteoporotic fracture. In 53 % GPs prescribed antiosteoporotic drugs, more often if the indication for treatment was less aggressive (p <0.001). Once prescribed, in 94 % of cases the GPs\' medication followed the specialists\' recommendations. 74 % of patients followed their GP\'s prescription. Patients most often stated a missing prescription as the reason for not taking drugs (39 %), whereas GPs cited a missing interest of their patients (44 %). The observed discrepancies call for a melioration in the communication between all parties involved.
Zusammenfassung. Im Rahmen eines Qualitätsprojekts zur Behandlung von Osteoporosefrakturen fiel auf, dass fachärztliche Therapie-Empfehlungen oftmals nicht umgesetzt wurden, was genauer untersucht werden sollte. Durchgeführt wurde eine systematisch vergleichende Fragebogen-Evaluation bei Patienten wie Hausärzten (n = 151) ein Jahr nach empfohlener Osteoporosetherapie. In 53 % der Fälle folgten die Hausärzte der vom Spezialisten empfohlenen Osteoporosetherapie-Indikation, häufiger, wenn diese medizinisch enger gestellt wurde (p <0,001). Sofern der Patient eine hausärztliche Verordnung erhalten hatte, entsprach diese meist der Spezialisten-Empfehlung (94 %). 74 % der Patienten folgten der hausärztlichen Verschreibung. Patienten gaben am häufigsten eine fehlende Verordnung als Grund für die Nichteinnahme der vom Spezialisten empfohlenen Medikamente an (39 %), hingegen nannten Hausärzte am häufigsten ein Patienten-Desinteresse (44 %). Die beobachteten Diskrepanzen sprechen für einen Bedarf an verbesserter Information, insbesondere im Fall einer eher aggressiv gestellten Therapieindikation.

The relationship between specialist physician and primary care physician (PCP) has been poorly evaluated in France. We have studied the application of a specialist\'s recommendation by the PCP. Vaccination against hepatitis B in patients with chronic renal failure was the follow-up marker. After consultation, the nephrologist wrote in his report to the PCP that the vaccination was recommended. At the next nephrological consultation, the patient was asked if the PCP had proposed vaccination. The clinical, biological characteristics and history of the patients were recorded as well as number and location of the PCP consultations. Five nephrology centers recruited 315 patients. In 61.6% (194/315) of the cases, the vaccination was not proposed by the PCP. Only the estimated GFR (lowest in vaccinated patients, 29.5 vs. 34.5mL/min/1.73m2), the delay between the two consultations of the nephrologist (shorter in vaccinated patients, 18.7 vs. 22.9 weeks) and the nephrologist\'s practice center (17.5 to 52% vaccination rate) are statistically significant in univariate analysis. In multivariate analysis, only the center effect persists. The lack of vaccination was argued by a letter from the PCP in 2 cases (1%). In the absence of a direct questioning of the PCP, the reasons for not following the recommendation remain unexplained. Overall, the recommendation of the nephrologist was little followed. Our study can contribute to the reflection on the shared follow-up of patients suffering from chronic diseases.

Considering the trends in medicine, time just seems to move at a slower pace in general practice/family medicine than in the medical specialties. Novel medical drugs and therapeutic modalities appear to take longer to become well-established, and sometimes it never happens. There are obvious gaps between the requirements of the guidelines issued by scientific medical societies and the practical implementation of these guidelines by primary care physicians. In health services research this is known as the «evidence-performance gap». The aim of this narrative review is to outline the nature and the dynamics of trends in general practice/family medicine on the one hand and in the medical specialties on the other hand, and to elucidate the potential causes leading to the evidence-performance gaps observed.