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

BACKGROUND: Little is known about the management of patients with anginapectoris by GPs. OBJECTIVE: The purpose of this study was to assess how agroup of GPs managed a patient with angina pectoris complaints in areal-life practice setting during unbiased consultations with standardizedpatients. METHODS: GPs were consulted during normal surgery hours by astandardized patient portraying a patient with angina pectoris. The settingwas Trondheim, Norway. All 87 GPs in the city of Trondheim (Norway) wereinformed by letter about a study with standardized patients and invited totake part. They were asked to give consent to be visited during actualsurgery hours by standardized patients. The date, number and content of thevisits planned were not mentioned. They were not told that the studyfocused on angina pectoris. For budgetary reasons it was decided to ask 24physicians to participate. The GPs were consulted during normal surgeryhours by a standardized patient portraying a patient with angina pectoris.The patients reported on the consultations using a checklist based onguidelines for management of angina pectoris. Outcome measures were thecontent and number of actions undertaken from the guidelines. RESULTS:Twenty-eight GPs (32%) agreed to participate. Of these, 24 were selectedand visited. One doctor detected the standardized patient. The resultsshowed 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 inseven referrals (two for chest X-rays, four for an exercise test and onereferral to a specialist in cardiology). Twenty-two of the 23 doctors madethe correct diagnosis and informed the patient accordingly. CONCLUSIONS:When assessed in an unbiased situation in real practice, GPs performed wellagainst a pre- set standard for management of angina pectoris patients.Much variation was found in the request for laboratory tests. Thesereal-life practice data suggest that there is a need for discussingguidelines for effective ordering of laboratory tests in general practice.