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Reported treatment of hypertension by family physicians in Sweden and Minnesota: a physician survey of practice habits

Troein, Margareta LU ; Arneson, T; Råstam, Lennart LU ; Pirie, P L; Selander, S and Luepker, R V (1995) In Journal of Internal Medicine 238(3). p.215-221
Abstract
OBJECTIVES. To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent different national guidelines account for differences. DESIGN. Random samples of family physicians were selected for telephone interviews on their practice of hypertension. SETTING. Primary care in southern Sweden and in Minnesota. SUBJECTS. Family medicine specialists. Participation rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota. MAIN OUTCOME MEASURES. Cut-off levels, and non-pharmacological and pharmacological treatment of hypertension, related to three case scenarios: a 48-year-old man, a 65-year-old man and a 65-year-old woman. RESULTS. Swedish physicians reported significantly... (More)
OBJECTIVES. To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent different national guidelines account for differences. DESIGN. Random samples of family physicians were selected for telephone interviews on their practice of hypertension. SETTING. Primary care in southern Sweden and in Minnesota. SUBJECTS. Family medicine specialists. Participation rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota. MAIN OUTCOME MEASURES. Cut-off levels, and non-pharmacological and pharmacological treatment of hypertension, related to three case scenarios: a 48-year-old man, a 65-year-old man and a 65-year-old woman. RESULTS. Swedish physicians reported significantly higher levels of diastolic blood pressure than Minnesota physicians for the institution of treatment of hypertension for all case scenarios. In both countries, physicians adhered to the cut-off levels of their national guidelines in the case of the 48-year-old man. Minnesota physicians did not use age as a modifying factor for treatment cut-off levels, as did Swedish physicians. Swedish physicians emphasized alcohol, fat and stress reduction, and Minnesota physicians weight and salt reduction as non-pharmacological treatment. While Swedish physicians generally preferred beta-blockers, Minnesota physicians chose ACE inhibitors or calcium channel blockers as the first choice drug. CONCLUSION. Swedish and US guidelines on hypertension were identical except for higher cut-off level for drug treatment in Sweden. Minnesota physicians reported cut-off levels close to national guidelines. For 65-year-old patients, Swedish physicians reported applying a higher cut-off level than indicated by guidelines. Swedish physicians also reported preferring less expensive drugs. As a consequence of the differing national guidelines and the identified physicians' practice habits in the two medical communities, it is likely that the segments of the populations treated and the drug costs differ substantially. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Internal Medicine
volume
238
issue
3
pages
215 - 221
publisher
Wiley-Blackwell
external identifiers
  • pmid:7673850
  • scopus:0029090632
ISSN
1365-2796
language
English
LU publication?
yes
id
18f7109b-d826-44a1-a451-8916cb8e6de6 (old id 1108766)
date added to LUP
2008-07-24 16:18:42
date last changed
2017-01-01 07:08:18
@article{18f7109b-d826-44a1-a451-8916cb8e6de6,
  abstract     = {OBJECTIVES. To compare family physicians' reported practice habits on hypertension in Sweden and Minnesota, and to assess to what extent different national guidelines account for differences. DESIGN. Random samples of family physicians were selected for telephone interviews on their practice of hypertension. SETTING. Primary care in southern Sweden and in Minnesota. SUBJECTS. Family medicine specialists. Participation rates were 236/264 (89%) in Sweden and 183/209 (88%) in Minnesota. MAIN OUTCOME MEASURES. Cut-off levels, and non-pharmacological and pharmacological treatment of hypertension, related to three case scenarios: a 48-year-old man, a 65-year-old man and a 65-year-old woman. RESULTS. Swedish physicians reported significantly higher levels of diastolic blood pressure than Minnesota physicians for the institution of treatment of hypertension for all case scenarios. In both countries, physicians adhered to the cut-off levels of their national guidelines in the case of the 48-year-old man. Minnesota physicians did not use age as a modifying factor for treatment cut-off levels, as did Swedish physicians. Swedish physicians emphasized alcohol, fat and stress reduction, and Minnesota physicians weight and salt reduction as non-pharmacological treatment. While Swedish physicians generally preferred beta-blockers, Minnesota physicians chose ACE inhibitors or calcium channel blockers as the first choice drug. CONCLUSION. Swedish and US guidelines on hypertension were identical except for higher cut-off level for drug treatment in Sweden. Minnesota physicians reported cut-off levels close to national guidelines. For 65-year-old patients, Swedish physicians reported applying a higher cut-off level than indicated by guidelines. Swedish physicians also reported preferring less expensive drugs. As a consequence of the differing national guidelines and the identified physicians' practice habits in the two medical communities, it is likely that the segments of the populations treated and the drug costs differ substantially.},
  author       = {Troein, Margareta and Arneson, T and Råstam, Lennart and Pirie, P L and Selander, S and Luepker, R V},
  issn         = {1365-2796},
  language     = {eng},
  number       = {3},
  pages        = {215--221},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Internal Medicine},
  title        = {Reported treatment of hypertension by family physicians in Sweden and Minnesota: a physician survey of practice habits},
  volume       = {238},
  year         = {1995},
}