[Development and implementation of the dementia guideline of the German Society of General Practice and Family Medicine]. / Entwicklung und Implementierung der Leitlinie "Demenz" der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin.

The evidence-based guidelines of the German Society of General Practice and Family Medicine (DEGAM) are developed according to an established ten-stage plan. The twelfth guideline addresses the health care problem of dementia. The main focus is the sensitive handling of patients and their relatives, e.g., although the goal is an early diagnosis, patients should also be protected against overdiagnosis. The treatment of Alzheimer's disease consists of three components: optimal care and supervision, the use of nondrug therapy, and a critically weighed administration of medications. The successful implementation of the guideline should be achieved by a multimodal strategy. This includes not only the direct integration of general practitioners (GPs) in developing the guideline, but also a comprehensive publication offensive, a wide use in training sessions including new media, the testing of complex implementation approaches in trials, and the use of the guideline in the context of GP contracts.

Knowledge transfer for the management of dementia: a cluster randomised trial of blended learning in general practice.

BACKGROUND: The implementation of new medical knowledge into general practice is a complex process. Blended learning may offer an effective and efficient educational intervention to reduce the knowledge-to-practice gap. The aim of this study was to compare knowledge acquisition about dementia management between a blended learning approach using online modules in addition to quality circles (QCs) and QCs alone. METHODS: In this cluster-randomised trial with QCs as clusters and general practitioners (GPs) as participants, 389 GPs from 26 QCs in the western part of Germany were invited to participate. Data on the GPs' knowledge were obtained at three points in time by means of a questionnaire survey. Primary outcome was the knowledge gain before and after the interventions. A subgroup analysis of the users of the online modules was performed. RESULTS: 166 GPs were available for analysis and filled out a knowledge test at least two times. A significant increase of knowledge was found in both groups that indicated positive learning effects of both approaches. However, there was no significant difference between the groups. A subgroup analysis of the GPs who self-reported that they had actually used the online modules showed that they had a significant increase in their knowledge scores. CONCLUSION: A blended learning approach was not superior to a QCs approach for improving knowledge about dementia management. However, a subgroup of GPs who were motivated to actually use the online modules had a gain in knowledge. TRIAL REGISTRATION: Current Controlled Trials ISRCTN36550981.

Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula.

BACKGROUND: Problem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. METHODS: Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula. RESULTS: Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p < 0.001), except for "Medical knowledge" and "Research competence". Comparing competencies required at work and taught in medical school, PBL was associated with benefits in "Interdisciplinary thinking" (Delta + 0.88), "Independent learning/working" (Delta + 0.57), "Psycho-social competence" (Delta + 0.56), "Teamwork" (Delta + 0.39) and "Problem-solving skills" (Delta + 0.36), whereas "Research competence" (Delta--1.23) and "Business competence" (Delta--1.44) in the PBL-based curriculum needed improvement. CONCLUSION: Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development.

German ambulatory care physicians' perspectives on continuing medical education - a national survey.

INTRODUCTION: This survey aimed to investigate German ambulatory physicians' opinions about mandatory continuing medical education (CME) and CME resources shortly before the introduction of mandatory CME in 2004. METHODS: A structured national telephone survey of general practitioners and specialists was conducted. Main outcome measures were opinions about mandatory CME, preferred CME media, and financial aspects of CME. Data analysis applied Pearson's correlation coefficient for explorative analysis of correlations, analysis of variance for group comparison, and chi(2)-test for investigation of distribution of 2 or more categorical variables. RESULTS: Of the 511 participants, 73% felt that CME supported them in keeping up to date with new medical knowledge, yet only half believed in its ability to minimize medical errors or increase quality of patient care. Traditional ways of learning were preferred. Significant differences in CME behavior were found between primary-care physicians and specialists, the latter using more communicative media. Also, a small group of very skeptical physicians who do not agree with the need for CME in general was identified. Average expenditure for CME was estimated between 500 and 1000 Euros per year. A majority of physicians called for other parties, eg, health insurances or government, to share the financial responsibility for CME. DISCUSSION: Mandatory CME was accepted as a necessity already before the new legislation took effect, with prevailing skepticism at the same time. Future research is needed on how to motivate physicians and especially certain subgroups of physicians to use CME methods shown to be effective in changing clinical behavior.

Dementia care initiative in primary practice: study protocol of a cluster randomized trial on dementia management in a general practice setting.

BACKGROUND: Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support. However, the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive. Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers. The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement. In this paper the study protocol is described. METHODS/DESIGN: The IDA (Initiative Demenzversorgung in der Allgemeinmedizin) project is designed as a three armed cluster-randomized trial where dementia patients and their informal caregivers are recruited by general practitioners. Patients in the study region of Middle Franconia, Germany, are included if they have mild or moderate dementia, are at least 65 years old, and are members of the German AOK (Allgemeine Ortskrankenkasse) sickness fund. In the control group patients receive regular treatment, whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment, recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up. The study recruitment and follow-up took place from July 2005 to January 2009. 303 general practitioners were randomized of which 129 recruited a total of 390 patients. Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint. Secondary endpoints are cognitive status, activities of daily living, burden of care giving as well as healthcare costs. For an economic analysis from the societal perspective, data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance. DISCUSSION: From a public health perspective, the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector. For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness. TRIAL REGISTRATION: ISRCTN68329593.

General Practitioners' preferences and use of educational media: a German perspective.

BACKGROUND: Several studies suggest that General Practitioners (GPs) prefer "traditional" media such as journals or quality circles when they are seeking out different options to meet their continuing medical education (CME) requirements. A survey was designed in order to gain a better understanding of German General Practitioners' preferences for different forms of educational media that will meet their CME needs. METHODS: Four hundred and forty nine (N = 449) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings. The participating physicians received a standardized 26-item-questionnaire that surveyed their preferences for different forms of educational media. A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns. RESULTS: Two hundred and sixty-four physicians with an average age of 51.1 years participated (28.5% female, 71.5% male). We found that GPs favor learning environments such as: journals, colleagues, and quality circles. New media like the internet was used less often for their learning activities, even though the usage of the internet in general was quite high. The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability. CONCLUSION: Despite a growing use of the Internet it seems that German GPs favor "classical/traditional" settings for their learning activities. These results should be taken into consideration when planning CME or CPD programs or other learning activities. TRIAL REGISTRATION: Current Controlled Trials ISRCTN36550981.

[Primary care physicians, internet and educational media. Preferences, usages and appraisal in a 6-year comparison]. / Hausärzte, Internet und Fortbildungsmedien. Nutzung und Effizienzeinschätzung durch Allgemeinärzte und hausärztlich tätige Internisten im 6-Jahres-Vergleich.

BACKGROUND AND PURPOSE: Several studies suggest that primary care physicians prefer "traditional" media like journals or quality circles for their postgraduate medical education. This survey was designed to gain a better understanding of primary care physicians' learning media preferences. The actual results were compared with data from a survey with the same physicians conducted in 2001 to identify a change in their preferred learning media. METHODS: 57 primary care physicians (23% female, 77% male) took part in this survey. A standardized questionnaire was distributed which covered three topics: medical knowledge acquired after medical school, current use of and demands on medical education media. All participating physicians had already completed this questionnaire 6 years ago. Answers were compared on single-item level using Kendall's tau(c) correlation coefficient. Additionally, in 2007, there were a few items about internet and PDA ("personalized digital assistants") usage which were analyzed descriptively. RESULTS: For their continuing medical education primary care physicians predominantly indicated quality circles, scientific journals, and colleagues. The internet, pharmaceutical representatives, and scientific staff at research institutions were less used and less valued. The most favored attributes concerning medical education media were "reliable" and "relevant for daily practice", less favored were "interactive" and "pictorial". A high correlation between the results of the 2001 and the 2007 survey was found. CONCLUSION: The survey demonstrated the situation of medical education media from 57 primary care physicians and their learning media preferences in a 6-year comparison: their preferences remained relatively constant. Thus far, new media have still a minor role among the relevant educational media for primary care physicians despite the fact that the internet use, in general, was high. New education tools should be designed according to these preferences.

Knowledge translation on dementia: a cluster randomized trial to compare a blended learning approach with a "classical" advanced training in GP quality circles.

BACKGROUND: Thus far important findings regarding the dementia syndrome have been implemented into patients' medical care only inadequately. A professional training accounting for both, general practitioners' (GP) needs and learning preferences as well as care-relevant aspects could be a major step towards improving medical care. In the WIDA-study, entitled "Knowledge translation on dementia in general practice" two different training concepts are developed, implemented and evaluated. Both concepts are building on an evidence-based, GP-related dementia guideline and communicate the guideline's essential insights. METHODS/DESIGN: Both development and implementation emphasize a procedure that is well-accepted in practice and, thus, can achieve a high degree of external validity. This is particularly guaranteed through the preparation of training material and the fact that general practitioners' quality circles (QC) are addressed. The evaluation of the two training concepts is carried out by comparing two groups of GPs to which several quality circles have been randomly assigned. The primary outcome is the GPs' knowledge gain. Secondary outcomes are designed to indicate the training's potential effects on the GPs' practical actions. In the first training concept (study arm A) GPs participate in a structured case discussion prepared for by internet-based learning material ("blended-learning" approach). The second training concept (study arm B) relies on frontal medical training in the form of a slide presentation and follow-up discussion ("classical" approach). DISCUSSION: This paper presents the outline of a cluster-randomized trial which has been peer reviewed and support by a national funding organization--Federal Ministry of Education and Research (BMBF)--and is approved by an ethics commission. The data collection has started in August 2006 and the results will be published independently of the study's outcome. TRIAL REGISTRATION: Current Controlled Trials [ISRCTN36550981].

[Multimodal training of general practitioners--evaluation and knowledge increase within the framework of the dementia management initiative in general medicine (IDA)]. / Multimodale Schulung von Hausärzten - Evaluation und Wissenszuwachs im Rahmen der Initiative Demenzversorgung in der Algemeinmedizin (IDA).

BACKGROUND AND OBJECTIVE: In many industrialized countries diagnostic and therapeutic deficits in the management of patients with dementia are well documented. Due to demographic trends the next years will see a further rise in the number of affected patients. Accordingly, the knowledge and competence of the physicians taking care of these patients need to be keep up-to-date. In the context of the three-armed cluster-randomized IDA trial (IDA = "Initiative Demenzversorgung in der Allgemeinmedizin"; Dementia Management Initiative in General Medicine), general practitioners (GPs) from the trial area (Bavaria, Germany) were trained in the diagnosis and treatment of dementia. METHODS: The educational training concept was based on the evidence-based guideline of Witten/Herdecke University (UWH). All participating GPs (n = 137, January 2006) received three hours training in the diagnosis of dementia. In addition, a subgroup was trained for two hours in dementia therapy (n = 90). Both groups obtained information about the study design. The didactic concept included screen and oral presentations by opinion leaders, video and interactive elements. At the beginning of the training sessions participants had to fill in a pilot-tested questionnaire with 20 multiple choice questions addressing the diagnosis and therapy of dementia (pretest). The same questionnaire was completed at the end of the training session (posttest) complemented by an evaluation sheet. Overall and intergroup differences between pre- and post-test results (increase in knowledge) were compared using the Chi-Square test. RESULTS: Overall, the quality of the training received a positive rating by the participants. By the end of January 2006, 137 doctors had been trained. The mean knowledge gain was 4.0+2.6 correctly answered questions (p<0.001; Cl 3.6 to 4.5) comparing pre- and posttest (n = 132). In the group trained on diagnosis alone (n = 45), the gain averaged 2.0+/-1.9 questions. The group with additional training on therapy (n = 87) achieved a difference of 5.1 -2.3 questions (p<0.001). DISCUSSION: Participants of the dementia training achieved a substantial gain of knowledge. The extent of this knowledge increase was associated with the attendance to respective training modules. An ongoing trial will add further information about knowledge translation in the field of dementia.

[How to change physicians' practice--health services research with the knowledge-performance gap on focus]. / Das Knowledge-Performance-Gap im Fokus der Versorgungsforschung.

How can the knowledge-performance gap be bridged? The discrepancy between our scientific knowledge on the one hand and its inadequate application in everyday practice on the other remains a major challenge for implementation research. Looking back on ten years of Health Services Research and acknowledging the achievements of educational research we have gained access to a variety of research findings and tools describing how physicians'--and other health professionals'--behavior and performance in medical care may be influenced. The time has come for testing and evaluating them.

[EbM and patient perspective--a 5-step approach]. / Evidenzbasis und Patientenbedürfnis--ein Annäherungsversuch in fünf Schritten: Entwicklung einer evidenzbasierten und patientenorientierten Patientenleitlinie Asthma.

OBJECTIVES: Shared decision making describes a way of involving patients in the planning and management of their individual healing process. Doing this effectively seems to be quite a challenge for both physicians and patients. The mutual transfer of information appears to be one of the main steps of this process. Clinical patient information or patient guidelines can help to explain complex medical processes in a non-specialist way and thus improve communication and self-management. In order to develop an "evidence-based asthma patient guideline" we tried to focus on both evidence-based recommendations and patients' perspectives. Patients were asked about their individual needs and knowledge and took part in the subsequent review. METHODS: In order to explore patients' perspectives and needs we implemented two additional steps to our existing concept of guideline development: (1) a questionnaire for asthma patients with 10 items dealing with patients' knowledge about asthma and a personal grading of 16 "asthma-related questions", and (2) patients joining the actual guideline review panel. RESULTS: By evaluating the results of the questionnaire we discovered a gap between what patients consider to be interesting and/or important and what is necessary from the point of view of medicine and health policy. Although the patients showed a great interest in an autonomous approach to life with asthma [important items: "what can I do by myself" (68%); "how can I prevent an asthma attack" (86%); "how can I live a better life with asthma" (77%)], they were less interested in topics that would give them more autonomy ["structured educational programs" (41%); "how to use inhaling devices" (64%) or "peak flow measurement" (36%)]. Patients participating in the review panel emphasized the need for more or better information about pollution (i.e. ozone), complementary/alternative methods and the administration of cortisone during the asthma attack--topics that were not mentioned in the physicians' guideline. CONCLUSIONS: To acquire an "implementable" evidence-based patient guideline it is not sufficient to "translate" existing asthma guidelines into lay language. We should focus on the needs of individual asthma patients and the problems they encounter every day. Therefore patients should be asked what they want to know and what they do not know, and they should review the results and include their own views into the guideline. We applied this concept to the above mentioned evidence-based patient guideline and received a thematic ranking focused on patients' daily needs as well as a to-do list of topics that require increased attention (like peak flow measurement and structured education programs). The patients' perspectives changed our perspective on our patient guideline more than we expected.

[The future is chronic: German primary care and the Chronic Care Model--The comprehensive principles in the proactive treatment of the chronically ill]. / Die Zukunft ist chronisch: das Chronic Care-Modell in der deutschen Primärversorgung: Ubergreifende Behandlungsprinzipien einer proaktiven Versorgung für chronische Kranke.

BACKGROUND: In Germany, primary healthcare for patients with chronic diseases needs to be improved. Taking the example of depression, congestive heart failure, diabetes and diseases of the musculoskeletal system we analyzed to which extent the 'Chronic Care Model' allows for improvements. METHODS: Diagnosis-specific health assessment; adaptation of the 'Chronic Care Model' to the German healthcare system; peer reviewed discussions of the potentials for improving primary care of the chronically ill. RESULTS/DISCUSSION OF THE HEALTHCARE SITUATION: 1) Diagnosis and therapy of chronic diseases comply insufficiently with the evidence. 2) Patients are too passive and/or receive only little effective support. 3) Treatments are often uncoordinated and fragmented. 4) The follow-up of treatment results is often neglected. 5) Approaches to indicated diseases are promising. CONCLUSIONS: The'Chronic Care Model' could improve chronic care in Germany. Disease Management Programs (DMP) should amend multimorbidity and individual healthcare and/or facilitate implementation in general practice.

German ambulatory care physicians' perspectives on clinical guidelines - a national survey.

BACKGROUND: There has been little systematic research about the extent to which German physicians accept or reject the concept and practice of a) clinical practice guidelines (CPG) and b) evidence based medicine (EBM)The aim of this study was to investigate German office-based physicians' perspective on CPGs and EBM and their application in medical practice. METHODS: Structured national telephone survey of ambulatory care physicians, four thematic blocks with 21 questions (5 point Likert scale). 511 office-based general practitioners and specialists. Main outcome measures were the application of Clinical Practice Guidelines in daily practice, preference for sources of guidelines and degree of knowledge and acceptance of EBM. In the data analysis Pearson's correlation coefficient was used for explorative analysis of correlations. The comparison of groups was performed by Student's t-test. Chi2 test was used to investigate distribution of two or more categorical variables. RESULTS: Of the total study population 55.3% of physicians reported already using guidelines in the treatment of patients. Physicians in group practices (GrP) as well as general practitioners (GP) agreed significantly more with the usefulness of guidelines as a basis for patient care than doctors in single practices (SP) or specialists (S) (Student's t-test mean GP 2.57, S 2.84, p < 0.01; mean GrP 2.55, SP 2.80, p < 0.05). 33.1% of the participants demonstrated a strong rejection to the application of guidelines in patient care. Acceptance of guidelines from a governmental institution was substantially lower than from physician networks or medical societies (36.2% vs. 53.4% vs. 62.0%). 73.8% of doctors interpret EBM as a combination of scientific research and individual medical knowledge; 80% regard EBM as the best basis for patient care. CONCLUSION: Despite a majority of physicians accepting and applying CPGs a large group remains that is critical and opposed to the utilization of CPGs in daily practice and to the concept of EBM in general. Doctors in single practice and specialists appear to be more critical than physicians in group practices and GPs. Future research is needed to evaluate the willingness to acquire necessary knowledge and skills for the promotion and routine application of CPGs.

[Shared decision making. The perspective of practicing physicians]. / "Shared Decision Making"Gemeinsame Entscheidungsfindung aus der ärztlichen Perspektive.

BACKGROUND AND PURPOSE: More and more, patients want to participate in medical decision making. They expect a patient-centered communication as well as adequate information. However, little is known about the physicians' perspective and skills regarding shared decision making (SDM). This paper presents data about the physicians' perspective and allows focused comparison with the patients' views. METHODS: Standardized survey of 502 physicians from ambulatory care practices and of 1,512 German-speaking people, aged 18-79 years. Patient data were collected from a population-based random sample of an access panel. The following topics were included in this survey: medical decision making in daily practice, communication skills and behavior of physicians from the perspectives of physicians and patients. RESULTS: A majority of physicians approve the concept of SDM. Especially younger physicians favor the concept of SDM. Overall, physicians underestimate their patients' preference to participate in medical decision making. Physicians also tend to overestimate their information and communication skills. CONCLUSION: Not only in the general public, but also among physicians, a model of SDM is widely accepted. The communication skills necessary for this process appear to exist. However, they need to be promoted and extended. Learning to communicate adequately should receive a greater focus in medical education and postgraduate training.

[Evidence-based medicine in professional training and education in practice? The integrated evidence-based medicine curriculum at the Medical School at the University of Witten/Herdecke]]. / Evidenzbasierte Medizin: Eingebettet in die Ausbildung--Selbstverständlich in der Praxis? Das integrierte EbM-Curriculum im Modellstudiengang Medizin der Universität Witten/Herdecke.

Applying the principles of evidence-based medicine in clinical practice is becoming more and more important for healthcare professionals in Germany. In this context Witten/Herdecke University has implemented an EbM Curriculum for medical students that is closely related to problem-based learning and clinical rotations within the scope of the six-year medical reform curriculum. Starting with the first semester, students will be able to acquire the necessary skills to search medical databases, to critically review the information retrieved according to EbM standards, to gather evidence for answering diagnostic or therapeutic questions during their clinical education and to ultimately participate in the development of clinical guidelines during their last year.

Looking back on back pain: trial and error of diagnoses in the 20th century.

CONTEXT: The societal costs of low back pain and associated disability are immense. However, very little is known about the etiology of low back pain. Lumbar disc disease was discovered in the last century and became the predominant etiology for back pain. Today we know that for the majority of low back pain cases, a specific etiology cannot be determined. OBJECTIVE: To analyze the evolution of the "disc paradigm" and to compare our contemporary understanding to the scientific discussion in the beginning of the last century. DESIGN: Survey of the highest ranked German medical journal from 1900 to 1999. DATA EXTRACTION: The indexes of 5185 journal issues of the Deutsche Medizinische Wochenschrift were reviewed for articles about low back pain. DATA SYNTHESIS: For each article, the etiologies were identified, categorized, and counted per decade. In addition, each important etiology was described. CONCLUSIONS: In the beginning of the last century, many heterogeneous etiologies coexisted. In the second half of the century, the theory of disc degeneration took over almost the entire literature about low back pain. Pre-existing theories disappeared, but re-entered the discussion in the last decade. Two factors seemed to influence this development: 1) a tendency to prefer organic, visible abnormalities as etiologies; and 2) an inclination to trust technical diagnostic results more than clinical judgment.

[Family physicians, the internet and new knowledge. Utilization and judgment of efficiency of continuing education media by general physicians and internists in family practice]. / Hausärzte, Internet und neues Wissen. Nutzung und Effizienzeinschätzung von Fortbildungsmedien durch Allgemeinärzte und hausärztlich tätige Internisten.

BACKGROUND AND OBJECTIVE: The application of new information technologies has a lasting impact on the physicians' working environment. Not only practice administration is undergoing substantial change, increasingly, individual learning preferences and continuing medical education are influenced by new media. This survey is designed to demonstrate current methods of and demand for continuing medical education by primary care physicians. METHODS: Standardized survey of 72 primary care physicians (21% female, 79% male) regarding three topics: medical knowledge acquired after medical school, current use of and expectations for continuing medical education tools. RESULTS: Primary care physicians estimate the fraction of their knowledge which was acquired after medical school at 60%. For their continuing medical education primary care physicians predominantly use scientific journals, colleagues and quality circles. The internet, scientific staff at research institutions and pharmaceutical representatives were less valued and less used. The most favored attributes for continuing medical education tools were: reliable, relevant for daily practice, and user-friendly. CONCLUSION: Continuing medical education is important and necessary. Thus far, new media still have a minor role among the relevant educational media for primary care physicians. The introduction of modern information technologies may become more successful if primary care physicians' preferences are better understood and education tools are designed according to these preferences.

[www.evidence.de--assessment and utilization of clinical guidelines by primary care physicians and internists]. / www.evidence.de--Netzbasierte Leitlinien im Praxistest. Beurteilung und Nutzung von evidenzbasierten und netzgestützten Leitlinien durch Allgemeinärzte und hausärztlich tätige Internisten.

BACKGROUND AND OBJECTIVE: Compared to the generation of new scientific results, implementation and utilization of evidence based knowledge is lacking far behind. Strengths and weaknesses of evidence- and HTML-based guidelines were evaluated in an academic network of primary care physicians to better understand the expectations and information needs of GPs. METHODS: Standardized survey of 72 primary care physicians (21% female, 79% male) regarding three network based issues: "frequency of guideline use", "reasons to use/not to use guidelines", "evaluation and overall judgement of guidelines". RESULTS: 62.9% of participating had used net based guidelines at least once, the percentage of more frequent users (> 2 times in two months) was 40.3%. Curiosity and non-specific interest as well as a concrete medical question were the main reasons for utilization of guidelines. The overall judgement of the guidelines was positive, however, only a minority of participating physicians viewed them as a concrete help in daily practice. CONCLUSION: Transformation of new scientific medical knowledge into daily primary care practice is only insufficiently developed. Netbased instruments of continuing medical education may serve as catalysts and should be further developed as well as evaluated.