Doctors’ Adherence to the Guidelines on the Diagnostics and Treatment of Arterial Hypertension

Abstract

Aim. Examination of knowledge of the basic provisions of clinical guidelines for the management of patients with arterial hypertension and finding out the readiness of doctors for the practical application of updated recommendationsMaterial and methods. Anonymous questionnaires of 306 doctors served as material for the study. The questionnaire consisted of two parts. The introductory part included questions that allow to find out the specialty, work experience, gender, age, and whether the respondent has cardiovascular risk factors. The main part of the questionnaire included 16 questions regarding provisions of the guidelines on the diagnosis and treatment of arterial hypertension in force at the time of the survey (2017/2018 academic year). Statistical processing of the results was carried out using the Microsoft Excel 2010 software package. Differences were regarded as significant at p<0.05.Results. The findings suggest that both therapists and cardiologists do not give due importance to the risk stratification of cardiovascular complications in patients with arterial hypertension and are not sufficiently aware of the possibilities and limitations of the use of combinations of antihypertensive drugs. Therapists worse than cardiologists know the main points of the clinical guidelines for the management of patients with arterial hypertension (target blood pressure levels during treatment [64.6% vs 87.7%, p<0.001], indications for combination antihypertensive therapy starting, the possibility of fixed dose combinations using [52.3% vs 83.9%, p<0.001]). A significant part of physicians (both cardiologists and therapists) adequately assess the antihypertensive treatment effectiveness, not enough frequent achievement of the target blood pressure level in their patients and is willing to provide more strict control of blood pressure.Conclusion. The results of the survey indicate the need of the active education of doctors in the management of patients with arterial hypertension. The most attention should be paid to the training of therapists and general practitioners on the cardiovascular complications risk stratification, the using of the antihypertensive drugs combinations use and methods to increase patient adherence to antihypertensive therapy.

Problematic issues and development of classifications of the main parameters of quality and adherence to pharmacotherapy. Part II: physician adherence to clinical guidelines and official drug labels

“…Основными критериями исследований приверженности врачей КР являются выбор и назначение ЛП с доказанной эффективностью, достижение целевых дозировок (например, у пациентов с хронической сердечной недостаточностью), целевых значений ряда показателей (артериального давления, холестерина липопротеинов низкой плотности, международного нормализованного отношения, гликированного гемоглобина и др.) [2,13,[23][24][25][26].…”

Effective antihypertensive therapy: focus on adherence management

“…Недостаточная результативность антигипертензивной терапии (АГТ) может быть связана с неточной диагностикой, неверной стратификацией рисков [4], погрешностями измерения артериального давления (АД), резистентностью к терапии [5]. Одной из наиболее распространенных причин неэффективности лечения является несоблюдение рекомендаций по лекарственной терапии и коррекции образа жизни, что, зачастую, остается не выявленным [6,7].…”

Methodological aspects of programs’ updating for advanced training of doctors

“…Mainly, the reason to update educational programs is the publication of the next edition of clinical guidelines for the diagnosis and treatment of this or that disease approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. These documents must be revised at least once every three years 6 . Updating the content of educational programs often requires correcting the ratio of time spent on considering individual topics within the approved forms of information presentation.…”

“…Another survey was devoted to the study of doctors' adherence to recommendations on the diagnosis and treatment of arterial hypertension [6]. As a result of this work, it was found that doctors do not give due weight to the cardiovascular events risk stratification in patients with arterial hypertension and are not sufficiently aware of the possibilities and limitations of the use of antihypertensive drugs combinations.…”