Measuring Adherence to Practice Guidelines for the Management of Hypertension

Abstract

Abstract-Adherence to practice guidelines is frequently used as a measure of quality of care. Numerous studies have evaluated physician adherence to hypertension guidelines by prescription data, physician survey data, or medical record review. However, most have methodological limitations that might underestimate physician adherence. Accurate and meaningful characterization of adherence rests on evaluation of varied components of hypertension care, use of explicit validated performance measures, incorporation of implicit and explicit review, and linkage of process measures to blood pressure outcomes. Key Words: hypertension, detection and control Ⅲ population Ⅲ lifestyle Ⅲ epidemiology P ractice guidelines serve as useful tools for clinical decision making. Guidelines are used to reduce practice variation, guide appropriateness, and measure quality of care. 1,2 Ultimately, the goal of a guideline is to improve patient outcomes through a change to evidence-based physician practices. Unfortunately, substantial gaps have been documented between the development and dissemination of consensus statements and their implementation in practice. In short, clinical practice guidelines do not consistently change physician behavior. [3][4][5][6][7] Although the National Heart, Lung, and Blood Institute (NHLBI) has published 7 guidelines for the treatment of hypertension, 8 -14 control of high blood pressure remains suboptimal. An estimated 40% of the 50 million persons in the United States with hypertension remain untreated, and 66% of hypertensive patients have blood pressure values that are not controlled to the recommended levels. 14,15 Many studies have concluded that physician adherence to hypertension guidelines has been low. 16 -22 It is tempting, therefore, to connect poor blood pressure control to poor adherence to hypertension guidelines.However, valid and meaningful conclusions regarding physician adherence and its link to blood pressure control rest on the completion of 2 tasks. First, physician adherence to hypertension guidelines must be assessed accurately. Second, the relation between physician adherence and blood pressure control must be empirically demonstrated.This article reviews pertinent literature regarding physician adherence to hypertension guidelines and the relation of adherence to blood pressure outcomes. The review focuses on methods that limit evaluation of adherence and concludes with recommendations for strengthening future adherence research. Literature SearchA literature search using MEDLINE from 1966 to 2004 was conducted by combining the terms "guideline adherence" and "hypertension." English articles were screened for inclusion by review of the title and abstract. A copy of all studies that compared prescribing trends or physician practice to guideline recommendations was obtained. Bibliographies of chosen references were reviewed for additional citations. Articles that compared physician practice to recommendations of the Joint National Committee (JNC) on the Detection, Evaluation, and ...

Hypertension Guideline Adherence Among Nursing Home Patients

“…Second, we accounted for patient comorbidities, which may affect recommended antihypertensive regimens. 15,16 Finally, we clearly defined adherence as use of a thiazide diuretic.…”

Physician-adherence to pharmacotherapy guidelines for chronic heart failure in a tertiary health facility in Lagos, Nigeria

“…Interestingly, ours was higher than the ACEI/ARB adherence noted in Japan [14] , and rural Australia [19] . Other authors have suggested that class of physicians or seniority of physicians may influence level of knowledge and adherence [14][15][16] .…”

“…The findings may not be generalized to other levels of the health care community. However, the performance at this level is relevant and requires study, for audit and practice evaluation [16,17] .…”

“…Physician-adherence is one strategy to improve the dismal outcome in CHF [1, 2, 10-12, 14, 15] . Generally guidelines have been known to influence quality of care, and have been used as a performance measure for health facilities [12,16,17] . Globally, in recent times, multiple publications on physician-adherence to CHF guidelines attest to its growing importance [11,12,14,15,[18][19][20] .…”

Canada Chair in hypertension prevention and control: A pilot project

“…Key Words: Education; Epidemiology; High blood pressure; Hypertension; Knowledge translation; Public health; Sodium; Surveillance Le Canada : À la barre d'un projet pilote sur la prévention de l'hypertension artérielle et la normalisation de la pression artérielle Improving the treatment and control of hypertension within the health care system Suboptimal detection, management and follow-up of hypertension are frequent problems in Canada, and several surveys indicate large practice 'gaps' in the management of hypertension by health care professionals (10)(11)(12)(13)(14)(15)(16)(17)(18). The Canadian Hypertension Education Program (CHEP) is an extensive effort that was developed to improve clinical hypertension management in Canada (19)(20)(21)(22)(23)(24).…”