Hypertension guideline recommendations in general practice: Awareness, agreement, adoption, and adherence

Carl Heneghan, Rafael Perera, David Mant, Paul Glasziou

Research output: Contribution to journalArticleResearchpeer-review

70 Citations (Scopus)

Abstract

Background

GPs vary greatly in their clinical management of hypertension, for reasons that are poorly understood.

Aim

To explore GPs' awareness of current hypertension guidelines and their self-reported implementation of them in clinical practice.

Design of study

Questionnaire survey via the internet.

Setting

Primary care.

Method

Survey of GPs (n = 401), based on the 'awareness-to-adherence' model of behavioural change.

Results

While 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.

Conclusion

The 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.

Original languageEnglish
Pages (from-to)948-952
Number of pages5
JournalBritish Journal of General Practice
Volume57
Issue number545
DOIs
Publication statusPublished - Dec 2007
Externally publishedYes

Cite this

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abstract = "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.",
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Hypertension guideline recommendations in general practice : Awareness, agreement, adoption, and adherence. / Heneghan, Carl; Perera, Rafael; Mant, David; Glasziou, Paul.

In: British Journal of General Practice, Vol. 57, No. 545, 12.2007, p. 948-952.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - 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.

AB - 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.

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