Self-reported hypertension treatment beliefs and practices of primary care physicians in a managed care organization
ABSTRACT Blood pressure (BP) is controlled to recommended goal in less than one-third of people with hypertension. There has been little recent research on physician beliefs and practices with regard to the treatment of hypertension.
In late 1999, we surveyed 104 primary care physicians in the 18 owned clinics of a large staff model, non-profit health maintenance organization. The survey included questions about demographics, BP treatment goals for patients with uncomplicated hypertension, and beliefs about hypertension.
The reported systolic BP treatment goal was < or =140 mm Hg for 97% and the diastolic BP goal was < or =90 mm Hg for 100%. The systolic BP goal for patients with isolated systolic hypertension was < or =140 mm Hg for 82%, but 34% stated that they would treat to a different goal depending on the diastolic BP. The proportions of physicians who would intensify treatment for BP of 140/90 mm Hg, 150/95 mm Hg, 165/75 mm Hg, and 165/65 mm Hg were 64%, 97%, 89% and 77%, respectively. Although 93% believed that medication was necessary to control BP in most cases, a majority (55%) agreed with the statement that BP could be controlled in most patients with only one drug. Although 42% reported that they often had to change drugs because of side effects, only 16% believed that it was time-consuming to find a well-tolerated drug regimen.
In this setting, primary care physicians' self-reported practices were in good agreement with national guidelines put forth in the late 1990s, and their beliefs were favorable to therapy. Our data point to a need for interventions to emphasize that combination drug therapy is frequently required to achieve BP control, and that more aggressive intervention is often warranted for isolated systolic hypertension.
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ABSTRACT: Despite the availability of effective therapy, hypertension remains poorly controlled and noncompliance has been identified as the predominant reason for failure of hypertension therapy. The aim of this study is to explore, (a) the patient¿s reports about their adherence and difficulties for the fulfillment of the treatment; (b) the relationship between information they had received about the consequences for health of hypertension and what they really believed about; (c) the patients¿ beliefs about the hypertension as a disease; and (d) the change in their way of living after the diagnosis. 171 hypertensive patients participated. Results shows that only 11,7% of patients reported not having problems to follow treatment, identifying as the main difficulties the adherence to diet and exercise; a high percentage of patients showed no correspondence between their beliefs about the consequences of hypertension and the information received in medical consultation; only 57% of the patients reported to have the idea of hypertension as a chronic disease; and 40,9% of the patients reported only some changes in their way of life after being diagnosed which might indicate failures in adherence at the beginning of the treatment. The importance of these results to improve adherence to treatment in hypertensive patients is discussed.
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ABSTRACT: Failure of physicians to adhere to hypertension guidelines may partly account for the failure to achieve blood pressure (BP) goals in clinical practice. The aim of this trial is a comprehensive description of the approach of physicians in the management of high BP among primary care patients. It will primarily assess what are the Reasons for not Intensifying an Antihypertensive Treatment (RIAT), when predefined individual BP goals are not achieved. Open intervention survey was conducted in 17 countries in Latin America, Eastern Europe, Africa and Asia in family practices, government and private clinics. The registry is based on a three-step epidemiological design. Step one shall identify guidelines and recommendations taken as reference in each country for the management of hypertension. Step two will assess the variance between individual targets defined by physicians in their practice compared to guidelines and recommendations. Step three is a prospective registry where physicians collect patient data at baseline; determine individual target BP values. Several follow-up visits are proposed to monitor achievement of these targets. Step three of RIAT aims at providing responses to several key objectives. Recruitment is under way aiming at enrolling 33,000 patients. To identify, what is the BP targeted according to the risk factor profile and what are the reasons for not modifying an antihypertensive treatment when BP goals are not reached, and to analyse the type of antihypertensive drugs prescribed according to compelling indications and to assess the percentage of patients reaching target figures.Journal of Human Hypertension 02/2006; 20(1):31-6. DOI:10.1038/sj.jhh.1001937 · 2.69 Impact Factor