Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

Adedeji, Asafa R.; Tumbo, John; Govender, Indiran

doi:10.4102/phcfm.v7i1.776

Cited by 40 publications

(52 citation statements)

References 13 publications

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“…Besides clinical variables, the potential influence of physician preference and degree of familiarity with/attitude toward ESC guidelines, which promote use of FDCs over free‐dose combinations, cannot be overlooked . For example, previous studies have associated older practitioner age with poorer adherence to guidelines on the management of hypertension . Furthermore, the disparity between prescription behaviors in what were formerly Eastern and Western Germany may also be related to physician factors.…”

Section: Discussionmentioning

confidence: 99%

“…7 For example, previous studies have associated older practitioner age with poorer adherence to guidelines on the management of hypertension. 18 Furthermore, the disparity between prescription behaviors in what were formerly Eastern and Western Germany may also be related to physician factors. Evidence suggests that in the east, the average age of practitioners is lower and hypertension is more prevalent 19,20 ; thus, it may be speculated that doctors in the east refer and adhere to guidelines more often.…”

Section: Factorsassociatedwiththeprescriptionofan Fdcratherthanafrementioning

confidence: 99%

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Fixed‐dose vs free‐dose combinations for the management of hypertension—An analysis of 81 958 patients

Bramlage

Schmidt

Sims

2018

J of Clinical Hypertension

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Fixed‐dose combinations (FDC) have been developed to reduce the pill burden for hypertensive patients. Data on fixed‐dose or free‐dose (freeDC) ramipril/amlodipine (R/A) or candesartan/amlodipine (C/A) combination treatment initiation were assessed. 71 463 patients were prescribed R/A and 10 495 C/A. For both R/A and C/A, FDC patients were younger (both P < .001) and less comorbid. Prior MI (OR: 0.61 and 0.60), prior stroke (OR: 0.68 and 0.70) and CHD (OR: 0.68 and 0.64) were negatively associated with FDC use, whereas hyperlipidemia was positively associated (OR: 1.26 and 1.19). Use of antihypertensive comedication (OR: 0.78; OR: 0.55) and treatment discontinuation within 12 months (HR: 0.65 and 0.82) were less likely in FDC patients, who also showed superior adherence (mean MPR; both P < .001). Cost of the combination was higher for FDCs (both P < .001). FDCs improve persistence and adherence, although they are more commonly prescribed in patients with less cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Section: Factorsassociatedwiththeprescriptionofan Fdcratherthanafrementioning

confidence: 99%

Fixed‐dose vs free‐dose combinations for the management of hypertension—An analysis of 81 958 patients

Bramlage

Schmidt

Sims

2018

J of Clinical Hypertension

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“…One important aspect that has not been well studied is that of the age of practitioners. There has been a change in practice over the generations with those clinicians in the second half of their careers practising as individuals according to their experience and knowledge whereas the younger generations are practising in a more collaborative team-based medicine which is more strongly influenced by protocols and guidelines [10].…”

Section: Not All Physicians Follow Guidelinesmentioning

confidence: 99%

Why are clinical practice guidelines not followed?

Barth

Misra

Aakre

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

144

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Abstract:Clinical practice guidelines (CPG) are written with the aim of collating the most up to date information into a single document that will aid clinicians in providing the best practice for their patients. There is evidence to suggest that those clinicians who adhere to CPG deliver better outcomes for their patients. Why, therefore, are clinicians so poor at adhering to CPG? The main barriers include awareness, familiarity and agreement with the contents. Secondly, clinicians must feel that they have the skills and are therefore able to deliver on the CPG. Clinicians also need to be able to overcome the inertia of "normal practice" and understand the need for change. Thirdly, the goals of clinicians and patients are not always the same as each other (or the guidelines). Finally, there are a multitude of external barriers including equipment, space, educational materials, time, staff, and financial resource. In view of the considerable energy that has been placed on guidelines, there has been extensive research into their uptake. Laboratory medicine specialists are not immune from these barriers. Most CPG that include laboratory tests do not have sufficient detail for laboratories to provide any added value. However, where appropriate recommendations are made, then it appears that laboratory specialist express the same difficulties in compliance as front-line clinicians.

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“…Non-adherence of doctors to guidelines is thought to contribute significantly to poor delivery of clinical care, resulting in poor clinical outcomes. 11 In a study done in the Bojanala district of South Africa overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). 20 Similar to the finding in the current study, the Bojanala study also found that the low adherence rates were related to age (older doctors) and the rates of adherence also differed with regard to various aspects of the guidelines.…”

Section: Adherence Practices To the Sti Guidelinesmentioning

confidence: 99%

“…10 There is also evidence that doctors do not always adhere to national treatment guidelines. 11 This study sought to determine the knowledge, attitudes and practices of doctors regarding syndromic STI management guidelines at Jubilee Hospital.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections

Uchenna

Govender

2018

South African Family Practice

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Background: Sexually transmitted infections (STIs) are a public health problem globally, but especially so in sub-Saharan Africa. They contribute significantly to the burden of disease in South Africa and are recognised as major contributors to the human immunodeficiency virus (HIV) epidemic, with other potential complications when not managed properly. First-line doctors play a critical role in the management of persons suffering from STIs, and need to comply with the national guidelines for STI management. Aim: To determine the knowledge, attitudes and practices of doctors working in Jubilee District Hospital, Metsweding region, Tshwane, regarding the STI syndromic management (SM) guidelines. Setting: Jubilee District Hospital in Tshwane North, Gauteng province, South Africa. Methods: A cross-sectional, descriptive study using a self-administered questionnaire was conducted. Results: Forty-three of the 50 doctors employed at the hospital participated in the study. Fourteen (32.6%) of the doctors were in the 36-40-year age group. Most of the doctors (36 or 83.7%) had only the basic bachelor's degree, and only 4 (9.3%) attended additional STI training. Only 2 respondents (4.6%) had correct knowledge concerning management of male urethritis syndrome and 10 (23.3%) regarding management of genital ulcer syndrome. In compliance with the national SM guidelines for STIs, 22 (52.4%) of the doctors said they made a diagnosis of STIs using history and physical examination. Only 7 (16.7%) said they asked their patients during every consultation about the number of sexual partners, 21 (51.7%) said they always counsel/ screen patients with STIs for HIV infection, and only 4 (9.5%) said they always filled in partner notification slips after attending to the index patient with STIs. This study demonstrated a relationship between doctors' knowledge of the SM guidelines for STIs and their age. Conclusion: Overall the knowledge and practices of doctors at Jubilee District Hospital were suboptimal, and training on the SM of STIs should be made available to address this. Management should introduce regular monitoring, evaluation and supportive services for the doctors regarding their management of STIs according to the guidelines.

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Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

Cited by 40 publications

References 13 publications

Fixed‐dose vs free‐dose combinations for the management of hypertension—An analysis of 81 958 patients

Fixed‐dose vs free‐dose combinations for the management of hypertension—An analysis of 81 958 patients

Why are clinical practice guidelines not followed?

Knowledge, attitudes and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections

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