Thresholds for taking antihypertensive drugs in different professional and lay groups: questionnaire survey

Steel, Nick

doi:10.1136/bmj.320.7247.1446

Cited by 81 publications

(59 citation statements)

References 3 publications

(2 reference statements)

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“…5,6 Self measurement is a better predictor of end organ damage than office measurement 7 and is well tolerated by patients. 8,9 Previous systematic reviews have found self monitoring of blood pressure to be associated with lower office systolic blood pressure (around 4 mmHg) as compared to conventional care but also found large variation in effect size with significant heterogeneity between studies. 5,10 No reviews have reported the effect of self monitoring using ambulatory blood pressure as the outcome.…”

Section: Introductionmentioning

confidence: 99%

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

et al. 2010

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Section: Introductionmentioning

confidence: 99%

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

et al. 2010

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“…This finding is consistent with earlier applications of the PDS and highlights that if interventions to assist consumers were developed solely from a health professional perspective, important issues to consumers could be missed. [9][10][11][12]27,28 The PDS methodology was successfully conducted in the Australian environment and would be a transportable method for other groups and for other countries to consider when seeking valuable insights into consumer perceptions and behaviour. Care should be taken, however, with extrapolation of these specific data.…”

Section: Resultsmentioning

confidence: 99%

“…Little is known about the consumer's perspectives regarding the management of hypertension, and whether these views align with the perspectives of the health professionals providing treatment for the condition. [25][26][27] This project had two principal aims: to test the PDS methodology and to use the method to derive insights into potential gaps between consumer and provider views about hypertension and its treatment. The detection function of the PDS can inform interventions aimed at improving the management of hypertension.…”

Section: Introductionmentioning

confidence: 99%

Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy

et al. 2003

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The objectives of this study were to ascertain consumer knowledge and behaviour about hypertension and treatment and to compare these with health care providers' perceptions (of 'most' consumers). The design for the study was a problem detection study (PDS): focus groups and then survey. Focus groups and survey participants were convenience samples of consumers, doctors, nurses and pharmacists. The main outcome measures were agreement on a 5-point Likert scale with statements about consumers' knowledge and behaviour about high blood pressure and medication. The survey identified areas of consensus and disagreement between consumers and health providers. While general knowledge and concordance with antihypertensive therapy among consumers was good, consequences such as eye and kidney disease, interactions with herbal medicines, and how to deal with missing a dose were less well known. Side effects were a problem for over one-quarter of participants, and cost was a problem in continuing therapy. Half the consumers had not received sufficient written information. Providers overall disagreed that most consumers have an adequate understanding of the condition. They agreed that most consumers adhere to therapy and can manage medicines; and about their own profession's role in information provision and condition management. Consumers confirmed positive provider behaviour, suggesting opportunities for greater communication between providers about actions taken with their consumers. In conclusion, the PDS methodology was useful in identifying consumer opinions. Differences between consumer and provider responses were marked, with consumers generally rating their knowledge and behaviour above providers' ratings of 'most' consumers. There are clear gaps to be targeted to improve the outcomes of hypertension therapy.

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“…5 Future appraisals of PDT (as with all new interventions) should now be preceded by the development of a consensus over what constitutes a clinically important degree of benefit, and recognise the need to consult more widely than solely ophthalmologists. 10 Trials often encounter recruitment problems when preceded by widespread acceptance of an intervention. 11 The variations in beliefs identified by this survey suggest that sufficient clinical uncertainty exists to support a further trial.…”

Section: Discussionmentioning

confidence: 99%

Introduction of photodynamic therapy for the treatment of neovascular age-related macular degeneration: tracking a moving target

Foot

Foy

Chakravarthy

et al. 2003

Eye

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Objectives To identify changes in referral and treatment patterns of neovascular agerelated macular degeneration with photodynamic therapy (PDT) within ophthalmology units in NHS hospitals and assess how beliefs about what would constitute a worthwhile level of clinical benefit had altered over a 12-month period. Methods Two questionnaire surveys (October 2000 and October 2001) to all clinical directors or lead consultants in UK NHS eye units. These sought data on which (if any) patients were referred or treated with PDT and the threshold of clinical benefit, in terms of numbers needed to treat, at which they would support the use of PDT. Results Response rates were 82% in the first survey and 79% in the second. The availability of PDT had significantly increased (P ¼ 0.0001). The proportion of units routinely providing PDT for patients with more than 50% classic subfoveal choroidal neovascularization (CNV) increased from 8 to 23%. Between the 2 surveys, there was a significant reduction in the threshold of effectiveness at which respondents would support the use of PDT (P ¼ 0.012). The proportion of respondents requiring further evidence before supporting the use of PDT decreased from 33 to 17% (P ¼ 0.009). There was a significant association between the threshold of support and the level of service provision for both surveys (P ¼ 0.01). Conclusions Although substantial variations exist, availability of PDT has increased over the 12-month period. The differing thresholds at which introduction of PDT would be considered justifiable varied widely. PDT is being introduced into the NHS in a fragmented manner. In common with other new health technologies, factors other than the strength of evidence appear to be influencing beliefs about the effectiveness of PDT and its subsequent provision. While it is unlikely that such an action alone will lead to evidencebased practice, the variations in beliefs identified by this survey suggest that sufficient clinical uncertainty exists to support the need for further clinical trials.

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Thresholds for taking antihypertensive drugs in different professional and lay groups: questionnaire survey

Cited by 81 publications

References 3 publications

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Using a problem detection study (PDS) to identify and compare health care provider and consumer views of antihypertensive therapy

Introduction of photodynamic therapy for the treatment of neovascular age-related macular degeneration: tracking a moving target

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