Barriers to adherence to hypertension guidelines among GPs in southern Sweden: A survey

Midlöv, Patrik; Ekesbo, Rickard; Johansson, L; Gerward, Sofia; Persson, Kristin A.; Nerbrand, Christina; Hedblad, Bo

doi:10.1080/02813430802202111

Cited by 42 publications

(35 citation statements)

References 20 publications

(18 reference statements)

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“…Clinical inertia, defined as “clinicians' failure to initiate or intensify drug treatment when indicated”, has been put forward as an obstacle to adequate prescribing, and to treatment targets being reached in practice [23, 24]. The inherent uncertainty of probabilistic reasoning has been suggested as one rationale for clinical inertia [10, 11, 13].…”

Section: Discussionmentioning

confidence: 99%

Clinical Gaze in Risk-Factor Haze: Swedish GPs’ Perceptions of Prescribing Cardiovascular Preventive Drugs

Hultberg

Rudebeck

2012

International Journal of Family Medicine

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Aims. To explore general practitioners' (GPs') descriptions of their thoughts and action when prescribing cardiovascular preventive drugs. Methods. Qualitative content analysis of transcribed group interviews with 14 participants from two primary health care centres in the southeast of Sweden. Results. GPs' prescribing of cardiovascular preventive drugs, from their own descriptions, involved “the patient as calculated” and “the inclination to prescribe,” which were negotiated in the interaction with “the patient in front of me.” In situations with high cardiovascular risk, the GPs reported a tendency to adopt a directive consultation style. In situations with low cardiovascular risk and great uncertainty about the net benefit of preventive drugs, the GPs described a preference for an informed patient choice. Conclusions. Our findings suggest that GPs mainly involve patients at low and uncertain risk of cardiovascular disease in treatment decisions, whereas patient involvement tends to decrease when GPs judge the cardiovascular risk as high. Our findings may serve as a memento for clinicians, and we suggest them to be considered in training in communication skills.

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Section: Discussionmentioning

confidence: 99%

Clinical Gaze in Risk-Factor Haze: Swedish GPs’ Perceptions of Prescribing Cardiovascular Preventive Drugs

Hultberg

Rudebeck

2012

International Journal of Family Medicine

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“…Diagnoses of atrial fibrillation, diabetes, CVD, and other comorbidities were defined by the standard list of clinical codes used to identify chronic diseases for the UK chronic disease monitoring programme (Quality and Outcomes Framework [QOF] business rules version 27 [31]), and, where present, “history of” or “resolved” clinical codes were extracted. Drug prescriptions corresponding to British National Formulary (version 67) chapters [32] for lipid-lowering, anticoagulant, and antihypertensive drugs and clinical codes indicating that the patient was on these drugs were extracted to identify treated patients. Clinical codes indicating that prevention drugs were declined or contraindicated, that a patient had white coat hypertension (for patients in whom antihypertensive drugs were clinically indicated), or that there was an adverse reaction were also extracted.…”

Section: Methodsmentioning

confidence: 99%

Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis

et al. 2016

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BackgroundStroke is a leading cause of death and disability; worldwide it is estimated that 16.9 million people have a first stroke each year. Lipid-lowering, anticoagulant, and antihypertensive drugs can prevent strokes, but may be underused.Methods and FindingsWe analysed anonymised electronic primary care records from a United Kingdom (UK) primary care database that covers approximately 6% of the UK population. Patients with first-ever stroke/transient ischaemic attack (TIA), ≥18 y, with diagnosis between 1 January 2009 and 31 December 2013, were included. Drugs were considered under-prescribed when lipid-lowering, anticoagulant, or antihypertensive drugs were clinically indicated but were not prescribed prior to the time of stroke or TIA. The proportions of strokes or TIAs with prevention drugs under-prescribed, when clinically indicated, were calculated.In all, 29,043 stroke/TIA patients met the inclusion criteria; 17,680 had ≥1 prevention drug clinically indicated: 16,028 had lipid-lowering drugs indicated, 3,194 anticoagulant drugs, and 7,008 antihypertensive drugs. At least one prevention drug was not prescribed when clinically indicated in 54% (9,579/17,680) of stroke/TIA patients: 49% (7,836/16,028) were not prescribed lipid-lowering drugs, 52% (1,647/3,194) were not prescribed anticoagulant drugs, and 25% (1,740/7,008) were not prescribed antihypertensive drugs.The limitations of our study are that our definition of under-prescribing of drugs for stroke/TIA prevention did not address patients’ adherence to medication or medication targets, such as blood pressure levels.ConclusionsIn our study, over half of people eligible for lipid-lowering, anticoagulant, or antihypertensive drugs were not prescribed them prior to first stroke/TIA. We estimate that approximately 12,000 first strokes could potentially be prevented annually in the UK through optimal prescribing of these drugs. Improving prescription of lipid-lowering, anticoagulant, and antihypertensive drugs is important to reduce the incidence and burden of stroke and TIA.

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“…Less frequently identified barriers were related to the perceived quality of the clinical practice guidelines and evidence, or patient concerns [6]. Barrier assessments that have been conducted since the 2007 review identified fewer barriers, and the most frequent barriers were related to the guidelines themselves, patients, and support or resources [7-9]. For example, respondents were concerned that guidelines were not evidence-based, were not relevant to the population, were too complex, and they simply did not agree with the guideline recommendations.…”

Section: Introductionmentioning

confidence: 99%

“…The identified barriers differed by type of guideline, demographics of providers, and type of practice setting. Interestingly, respondents in the more recent studies identified relatively few barriers related to physician characteristics other than a need for training and critical appraisal skills [7-9]. …”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to the implementation of clinical practice guidelines: A cross-sectional survey among physicians in Estonia

Taba

Rosenthal

Habicht³

et al. 2012

BMC Health Serv Res

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BackgroundIn an era when an increasing amount of clinical information is available to health care professionals, the effective implementation of clinical practice guidelines requires the development of strategies to facilitate the use of these guidelines. The objective of this study was to assess attitudes towards clinical practice guidelines, as well as the barriers and facilitators to their use, among Estonian physicians. The study was conducted to inform the revision of the clinical practice guideline development process and can provide inspiration to other countries considering the increasing use of evidence-based medicine.MethodsWe conducted an online survey of physicians to assess resource, system, and attitudinal barriers. We also asked a set of questions related to improving the use of clinical practice guidelines and collected free-text comments. We hypothesized that attitudes concerning guidelines may differ by gender, years of experience and practice setting. The study population consisted of physicians from the database of the Department of Continuing Medical Education of the University of Tartu. Differences between groups were analyzed using the Kruskal-Wallis non-parametric test.Results41% (497/1212) of physicians in the database completed the questionnaire, comprising more than 10% of physicians in the country. Most respondents (79%) used treatment guidelines in their daily clinical practice. Lack of time was the barrier identified by the most physicians (42%), followed by lack of medical resources for implementation (32%). The majority of physicians disagreed with the statement that guidelines were not accessible (73%) or too complicated (70%). Physicians practicing in outpatient settings or for more than 25 years were the most likely to experience difficulties in guideline use. 95% of respondents agreed that an easy-to-find online database of guidelines would facilitate use.ConclusionsUse of updated evidence-based guidelines is a prerequisite for the high-quality management of diseases, and recognizing the factors that affect guideline compliance makes it possible to work towards improving guideline adherence in clinical practice. In our study, physicians with long-term clinical experience and doctors in outpatient settings perceived more barriers, which should be taken into account when planning strategies in improving the use of guidelines. Informed by the results of the survey, leading health authorities are making an effort to develop specially designed interventions to implement clinical practice guidelines, including an easily accessible online database.

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Barriers to adherence to hypertension guidelines among GPs in southern Sweden: A survey

Abstract: These data suggest that GPs accept higher blood pressure levels than recommended in clinical guidelines. Old age of the patient seems to be an important barrier among GPs when considering pharmacological treatment for the management of hypertension.

Cited by 42 publications

References 20 publications

Clinical Gaze in Risk-Factor Haze: Swedish GPs’ Perceptions of Prescribing Cardiovascular Preventive Drugs

Clinical Gaze in Risk-Factor Haze: Swedish GPs’ Perceptions of Prescribing Cardiovascular Preventive Drugs

Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis

Barriers and facilitators to the implementation of clinical practice guidelines: A cross-sectional survey among physicians in Estonia

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