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

Nezafat, Amir Vatani; Tavakolifard, Negah; Vaezi, Atefeh

doi:10.4103/ijpvm.ijpvm_379_19

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…This, in turn, leads to an increase in workload and resistance to change among doctors, ultimately resulting in noncompliance to CPGs. The studies also highlighted a lack of motivation and inadequate relationships among staff as additional barriers ( 32 , 34 , 38 – 41 ). Dishonesty within the system and a lack of commitment hinder teamwork and the implementation of guidelines.…”

Section: Resultsmentioning

confidence: 99%

The Outcomes, Barriers, and Facilitators of Implementing Clinical Prac-tice Guidelines in Iran: A Comprehensive Review

Ghobadi,

Behzadi,

Sabermahani

2024

ijph

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Background: Clinical practice guideline (CPGs) are highly valuable in enhancing healthcare efficiency as they lead to the selection of the best medical methods and reduction of their costs. Nevertheless, implementing CPGs in practice can be quite challenging, as they require alterations at individual, organizational, and health system levels. Therefore, we aimed to identify the outcomes, barriers, and facilitators associated with CPG implementation. Methods: We conducted an extensive search using Web of Science, PubMed, Scopus, Embase, and various non-English databases to gather quantitative, qualitative, and review studies on the implementation of CPGs from Jan 1, 1990, to Dec 26, 2022. Our analysis focused on the outcomes, barriers, and facilitators of CPG implementation, which categorized into four groups: policy-making, health system and hospitals, professional experts, and clinical guidelines. Results: After conducting a thorough review of 37 studies, the most significant outcomes were found to be reduced costs and enhanced quality of care. However, certain challenges, such as inadequate support, insufficient education, high work pressure, tight schedules, and a lack of unified and clear guidelines, hindered these improvements. To overcome these barriers, it is essential to prioritize effective leadership, improve work conditions, allocate necessary resources, create a structured framework for the guidelines, and simplify their content to fit the clinical circumstances. Conclusion: It is crucial to identify the outcomes and barriers associated with implementing CPGs to enhance professional performance, elevate the quality of care, and foster patient satisfaction. Developing effective strategies hinges on this awareness.

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Section: Resultsmentioning

confidence: 99%

The Outcomes, Barriers, and Facilitators of Implementing Clinical Prac-tice Guidelines in Iran: A Comprehensive Review

Ghobadi,

Behzadi,

Sabermahani

2024

ijph

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“…Physician knowledge and adherence to guidelines pose additional challenges. A Study in Iran reported that only 31.8% of physicians were familiar with clinical guidelines 40 , and family physicians adhered to only one-third of the recommendations in the national hypertension guideline 19 . Among cardiologists at a teaching hospital in Iran, only 60% exhibited high adherence to the ACC/AHA guidelines in managing cardiovascular disease risk factors 41 .…”

Section: Discussionmentioning

confidence: 99%

“…This debate underscores the need for country-speci c investigations to estimate hypertension burdens based on different guidelines In Iran, similar to many countries, JNC7 remains the predominant guideline for de ning and treating hypertension. Despite guidelines like IraPen, which is developed based on the World Health Organization (WHO) Package of essential noncommunicable disease (PEN) interventions for primary health care in lowresource settings (WHO PEN) 17,18 , and the national family physician HTN guideline 19 aligning with JNC7 thresholds, the recent slow adoption of the ACC/AHA guideline in Iran suggests a changing trend 20 . Hence, exploring the potential impact of different guidelines on hypertension stage prevalence in Iran is crucial.…”

Section: Introductionmentioning

confidence: 99%

Trends of Hypertension Stages among Iranian Adults from 2005 to 2025 using WHO STEPS studies: A Comparison among 2017 ACC/AHA, JNC7, and 2020 ISH Guidelines

Golestani,

Sheidaei,

Khosravi

et al. 2024

Preprint

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Reducing the prevalence of hypertension, a major risk factor with significant health and economic implications is a target outlined by The World Health Assembly. This study investigated the prevalence of hypertension stages in Iran from 2005 to a projection for 2025 by three different guidelines. Eight nationally and sub-nationally representative cross-sectional WHO STEPwise approach to NCD risk factor surveillance (STEPS) studies were conducted from 2005 to 2021 in Iran. Staging followed the Joint National Committee's seventh report (JNC7), the American College of Cardiology/American Heart Association's 2017 guidelines (ACC/AHA), and the International Society of Hypertension's 2020 guidelines (ISH). Using data from a total of 210,546 participants, ACC/AHA projected higher prevalence in stage 1 and stage 2 hypertension, particularly 35–44 and 45–54 age groups of males, each reaching approximately 35% in 2025. Stage 1 hypertension demonstrated a stable trend (about 17%) for ISH and JNC7, whereas ACC/AHA exhibited a significant decrease from 37.07–30.32% between 2005 and 2025. Conversely, all guidelines indicated a significant decreasing trend for stage 2 hypertension from 2005 to 2025 (ACC/AHA: 26.60–23.27%, JNC7 and ISH: about 9–6.6%). The study indicated that the prevalence of hypertension stages has not remarkably changed based on all guidelines in recent years and is projected to remain stable by 2025. The choice of guidelines should consider cost-effectiveness analyses and the available resources.

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“…It is shown that high LDL-C contributed to 16.1% of deaths and 7.8% of DALYs caused by non-communicable diseases (NCDs) in the Iranian population in 2019 4 . The high consumption of dietary fats, obesity, physical inactivity, non-adherence to treatment guidelines by patients and physicians, as well as the increasing consumption of carbohydrate-rich foods could predispose the Iranian population to dyslipidemia 5 – 9 . Meanwhile, the widespread prescribing of statins by general practitioners, restrictions on trans fats in edible oils, and increased public awareness of the risk factor are policies and trends that may decrease dyslipidemia prevalence in Iran 3 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021

Khanali,

Ghasemi,

Rashidi

et al. 2023

Sci Rep

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The study aimed to estimate the prevalence of lipid abnormalities in Iranian adults by demographic characterization, geographical distribution, and associated risk factors using national and sub-national representative samples of the STEPs 2021 survey in Iran. In this population-based household survey, a total of 18,119 individuals aged over 25 years provided blood samples for biochemical analysis. Dyslipidemia was defined by the presence of at least one of the lipid abnormalities of hypertriglyceridemia (≥ 150 mg/dL), hypercholesterolemia (≥ 200 mg/dL), high LDL-C (≥ 130 mg/dL), and low HDL-C (< 50 mg/dL in women, < 40 mg/dL in men), or self-reported use of lipid-lowering medications. Mixed dyslipidemia was characterized as the coexistence of high LDL-C with at least one of the hypertriglyceridemia and low HDL-C. The prevalence of each lipid abnormality was determined by each population strata, and the determinants of abnormal lipid levels were identified using a multiple logistic regression model. The prevalence was 39.7% for hypertriglyceridemia, 21.2% for hypercholesterolemia, 16.4% for high LDL-C, 68.4% for low HDL-C, and 81.0% for dyslipidemia. Hypercholesterolemia and low HDL-C were more prevalent in women, and hypertriglyceridemia was more prevalent in men. The prevalence of dyslipidemia was higher in women (OR = 1.8), obese (OR = 2.8) and overweight (OR = 2.3) persons, those residents in urban areas (OR = 1.1), those with inappropriate physical activity (OR = 1.2), patients with diabetes (OR = 2.7) and hypertension (OR = 1.9), and participants with a history (OR = 1.6) or familial history of CVDs (OR = 1.2). Mixed dyslipidemia prevalence was 13.6% in women and 11.4% in men (P < 0.05). The prevalence of lipid abnormalities was highly heterogeneous among provinces, and East Azarbaijan with 85.3% (81.5–89.1) and Golestan with 68.5% (64.8–72.2) had the highest and lowest prevalence of dyslipidemia, respectively. Although the prevalence of high cholesterol and LDL-C had a descending trend in the 2016–2021 period, the prevalence of dyslipidemia remained unchanged. There are modifiable risk factors associated with dyslipidemia that can be targeted by the primary healthcare system. To modify these risk factors and promote metabolic health in the country, action plans should come to action through a multi-sectoral and collaborative approach.

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

Cited by 4 publications

References 25 publications

The Outcomes, Barriers, and Facilitators of Implementing Clinical Prac-tice Guidelines in Iran: A Comprehensive Review

The Outcomes, Barriers, and Facilitators of Implementing Clinical Prac-tice Guidelines in Iran: A Comprehensive Review

Trends of Hypertension Stages among Iranian Adults from 2005 to 2025 using WHO STEPS studies: A Comparison among 2017 ACC/AHA, JNC7, and 2020 ISH Guidelines

Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021

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