Adherence of doctors to hypertension clinical guidelines in academy charity teaching hospital, Khartoum, Sudan

Abstract

Background Clinical guidelines are systematically proven statements that help physicians to make healthcare decisions for specific medical conditions. Non-adherence to clinical guidelines is believed to contribute significantly to poor delivery of clinical care, and hence poor clinical outcomes. This study aimed at investigating adherence of doctors to hypertension clinical guidelines in Academy Charity Teaching Hospital, Khartoum, Sudan. Methods A cross-sectional hospital-based study was conducted during the period from January 2017 to October 2017 on a sample of 150 doctors. Adherence of doctors to hypertension guidelines was measured through the modified JNC7 adherence tool. Descriptive statistics was used to summarize the data (mean, standard deviation, median) and analyzed by frequency tables. Chi square test used to determine association among categorized variables. Logistic regression analysis was conducted to determine the relation between adherence to hypertension guidelines and the explanatory variables. All statistical tests were considered statistically significant when p value < 0.05. Results Of the 150 participants, 92% (138/150) were aware of the major hypertension treatment guidelines. 71% (98/138) reported the use of guidelines recommendations in their practice. Whereas 52% (78/150) were aware of local Sudanese guidelines. High adherence rate was highly statistically associated with job titles ( p = 0.000), and also associated with age of the participants ( p = 0.024) and duration of clinical experience ( p = 0.012). However, the logistic regression analysis revealed despite all those variables were contributing to adherence to the treatment guidelines, only duration of clinical experience was statistically significant ( p = 0.022). Conclusion The overall adherence of doctors to hypertension treatment guidelines was very low. This study highlights how a gap in clinical governance contributes to low adherence to clinical guidelines. Establishing regular clinical audit, issuing regulations to enforce the use of updated guidelines, along with introducing training programs in hospitals and continuous assessment to the practicing doctors are suggested as crucial interventions. Considerable efforts to build clinical governance in Sudan are required.

Compliance With Guideline of Hypertension Management Among Health Practitioners in Illubabor and Buno Bedelle Zones, South West Ethiopia; 2020

“…This nding is lower than a nding from study in Malaysia which similarly revised medical record of patients and found 67.1% of them received guideline compliant treatment (33). It's also lower than a nding of compliance to Malaysian clinical practice guideline which indicated that two third (73.5%) of the entire treatment were in compliance with Clinical practice guideline(38), and fewer than the nding from South Africa with over all compliance of 51.9% (42). This poor compliance in the current study is because the study participants have very poor compliance to life style recommendations which is applied for only 79(20.6%) patients.…”

Doctors’ Knowledge, Attitude and Objective Adherence with Hypertension Guidelines in Quetta, Pakistan: A Cross-sectional Analytical Study

“…Based on the definition used in the current study, a total of 58.9% doctors had adequate knowledge of guidelines recommendations. In comparison, the percentage of doctors who were adequately aware about recommendations of hypertension guidelines was 73% in Malaysia, [23] 51.9% in Sudan, [26] 49.1% in Kuwait, [16] 23% in Germany [25] and 20.1% in Italy. [27] In the current study, doctors' with a mean knowledge score of 7.55 + 1.73 on 11 points scale comparatively performed better than the German and Italian doctors with their respective mean knowledge score of 5.3 and 4.9.…”

“…Similar to our finding, increase in doctors' age, senior job titles (consultant/specialist) and increased duration of clinical practice were significantly associated with their higher adherence with hypertension guidelines in studies conducted Sudan and Japan. [26,28] Likewise, a Malaysian study also found that consultants and specialists had significantly higher knowledge about recommendations of Malaysian hypertension guidelines. [23] In current study, the overwhelming majority of consultants and specialists were from cardiology and nephrology, where their likely involvement in the management of hypertension could be one of the possible reasons for their greater awareness about guidelines recommendations.…”

Adherence of general practitioners to the national hypertension guideline, Isfahan, Iran

“…In a study by Abdelgadir et al . on adherence of doctors to HTN guideline the only variable which contribute to the adherence rate was the duration of clinical work,[ 13 ] he found no association between age or job title with adherence rate. This is in line with the results of our study as we have found that more experience is associated with adherence to the guideline but the age of physicians has no significant effect.…”

“…[ 10 11 ] Different variables can influence physicians' adherence to guidelines such as lack of knowledge about the guideline or lack of agreement with recommendations, self-efficacy, environmental variables such as patients' preference[ 12 ] and also a gap in clinical governance. [ 13 ]…”