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Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia

Troein, M; Gardell, B; Selander, S and Råstam, Lennart LU (1997) In Journal of Internal Medicine 242(2). p.173-178
Abstract
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hypercholesterolaemia, hypertension, practice guidelines
in
Journal of Internal Medicine
volume
242
issue
2
pages
173 - 178
publisher
Wiley-Blackwell
external identifiers
  • pmid:9279295
  • scopus:0030856510
ISSN
1365-2796
DOI
10.1046/j.1365-2796.1997.00182.x
language
English
LU publication?
yes
id
d1c5ed4e-06b7-4202-aff4-604291b48a56 (old id 1111239)
date added to LUP
2008-07-17 09:57:43
date last changed
2017-05-28 04:16:45
@article{d1c5ed4e-06b7-4202-aff4-604291b48a56,
  abstract     = {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 &lt; 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 &lt; 0.001), whilst the proportions preferring ACE-inhibitors and calcium channel blockers have increased (P &lt; 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 &lt; 0.001 and P = 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P &lt; 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.},
  author       = {Troein, M and Gardell, B and Selander, S and Råstam, Lennart},
  issn         = {1365-2796},
  keyword      = {hypercholesterolaemia,hypertension,practice guidelines},
  language     = {eng},
  number       = {2},
  pages        = {173--178},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Internal Medicine},
  title        = {Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia},
  url          = {http://dx.doi.org/10.1046/j.1365-2796.1997.00182.x},
  volume       = {242},
  year         = {1997},
}