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Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia
Author(s) -
Troein M.,
Gardell B.,
Selander S.,
Råstam L.
Publication year - 1997
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.1997.00182.x
Subject(s) - medicine , primary care , public health , family medicine , pediatrics , nursing
Troein M, Gardell B, Selander S, Råstam L (Department of Community Medicine, Lund University, Malmö, and Stockholm Institute of Education, Stockholm, Sweden). Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia. J Intern Med 1997; 242 : 173–8. 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.