Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence
Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence
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DOI：
10.3399/096016407782604965
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发表时间：
2007-12-01
影响因子：
5.9
通讯作者：
Glasziou, Paul
中科院分区：
文献类型：
--
作者：
Heneghan, Carl;Perera, Rafael;Glasziou, Paul
背景 由于人们知之甚少的原因，全科医生在高血压的临床管理方面存在很大差异。旨在探讨全科医生对现行高血压指南的认识以及他们在临床实践中自我报告的实施情况。研究设计通过互联网进行问卷调查。设置初级保健。方法基于行为改变的“认识到遵守”模型对全科医生（n = 401）进行调查。结果虽然对建议的认识很高，但同意和采用但情况往往不那么严重。几乎所有从业者 (99%) 都了解他汀类药物治疗的指导，但只有不到一半的人（43%；95% 置信区间 [CI] 38-48%）在实践中遵守了建议。四分之三 (77%) 的人知道最初应该测量双臂血压，但只有 30% 的人同意这一建议 (95% CI = 26% 至 34%)，13% 的人 (95% CI = 10% 至 16%) 坚持这一建议。尽管采纳建议通常是在同意建议的基础上进行的，但 19% 的全科医生（95% CI = 15% 至 23%）报告称，他们在不知情或不同意的情况下遵守了他汀类药物治疗的经济激励指导。年龄、性别、毕业年份或担任的职位与认识、同意或采用水平之间没有发现显着关联。结论促进高血压指南应用所需的具体障碍和行动因每种临床行动而异。缺乏意识很少是问题所在。即使给予经济激励，大多数全科医生也不太可能实施他们不同意的指导内容。高度遵守需要一支善于反思的员工队伍，能够对支撑该指南的科学证据做出反应。
BackgroundGPs vary greatly in their clinical management of hypertension, for reasons that are poorly understood.AimTo explore GPs' awareness of current hypertension guidelines and their self-reported implementation of them in clinical practice.Design of studyQuestionnaire survey via the internet.SettingPrimary care.MethodSurvey of GPs (n = 401), based on the 'awareness-to-adherence' model of behavioural change.ResultsWhile awareness of recommendations was high, agreement and adoption were often less so. Almost all practitioners (99%) were aware of the guidance on statin therapy but fewer than half (43%; 95% confidence interval [CI] 38-48%) adhered to the recommendation in practice. Three-quarters (77%) were aware that blood pressure should initially be measured in both arms, but only 30% agreed with the recommendation (95% CI = 26 to 34%), and 13% (95% CI = 10 to 16%) adhered to it. Although the adoption of a recommendation was usually consequent on agreement with it, 19% of GPs (95% CI = 15 to 23%) reported adherence to financially-incentivised guidance on statin therapy without either being aware of it or in agreement with it. No significant association was found among age, sex, year of graduation, or post held and level of awareness, agreement, or adoption.ConclusionThe specific barrier and action needed to promote application of hypertension guidelines varies with each clinical action. Lack of awareness is seldom the problem. Most GPs are unlikely to implement elements of guidance they disagree with even if given financial incentives. High adherence requires a reflective workforce that can respond to the scientific evidence underpinning the guidance.