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Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia
M Troein1, B Gardell, S Selander
1Department of Community Medicine, Lund University, Malmö, Sweden.
Insights
Physician practice regarding hypertension and hypercholesterolaemia treatment has shifted, but not always aligned with guidelines. This suggests guidelines may not be effectively implemented or valued by physicians.
Area of Science:
- Cardiovascular medicine
- Primary care research
- Health services research
Background:
- Monitoring family physicians' practice patterns for hypertension and hypercholesterolaemia is crucial for public health.
- Understanding shifts in treatment protocols informs guideline development and implementation strategies.
Observation:
- A study surveyed Swedish family physicians in 1989, 1991, and 1993 regarding their management of hypertension and hypercholesterolaemia.
- Interviews focused on cut-off levels for treatment and preferred pharmacological agents using a standardized case scenario.
Findings:
- Physicians reported lower cut-off levels for hypertension treatment than recommended by guidelines.
- While beta-blockers decreased in preference for hypertension, ACE-inhibitors and calcium channel blockers increased.
- For hypercholesterolaemia, statins and fibrates gained preference over resins and nicotinic acid, with cut-off levels generally aligning with guidelines.
Implications:
- Current practice guidelines for hypertension and hypercholesterolaemia may not be achieving their intended impact on physician behavior.
- The effectiveness of guideline dissemination, implementation, and maintenance strategies requires re-evaluation.
- Further research is needed to understand physician perception and adherence to clinical practice guidelines.
Objective:
To monitor changes in family physicians' reported practice on hypertension and hypercholesterolaemia.
Design:
Random samples of physicians were selected for telephone interviews on their practice regarding cut-off levels and pharmacological treatment of hypertension and hypercholesterolaemia, related to a case scenario of a 48-year-old man, in 1989, 1991 and 1993.
Setting:
Primary care facilities in southern Sweden.
Subjects:
Specialists in family medicine, employed in public primary health care. Participation rates were in 187/201 (93%) in 1989, 236/264 (89%) in 1991 and 257/298 (86%) in 1993.
Main Outcome Measures:
Cut-off levels and drug treatment preferences for hypertension and hypercholesterolaemia.
Results:
During the period 1989-1993, decreasing mean cut-off levels for pharmacological treatment of hypertension (P < 0.001) were reported, below the levels of the guidelines. Although betablockers were first choice drug in all three surveys, the proportion preferring this has diminished (P < 0.001), whilst the proportions preferring ACE-inhibitors and calcium channel blockers have increased (P < 0.001 and P = 0.02, respectively). For drug treatment of hypercholesterolaemia, the mean cut-off level remained close to guidelines in all three surveys. The proportion of physicians suggesting resins and nicotinic acid as first choice drug had decreased (P < 0.001 and P = 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P < 0.001 and P = 0.048, respectively).
Conclusion:
Practice guidelines on hypertension and hypercholesterolaemia have not had the desired impact on physicians' reported practice. The reason for this might be that physicians did not value the guidelines as adequate tools for practice, or that the methods for dissemination, implementation, and maintenance of guidelines were not appropriate.