Health

Physician education not enough to increase use of care guidelines

Study finds academic detailing about hypertension does not make it more likely that the relevant guidelines will be followed.

By Victoria Stagg Elliott — Posted Feb. 17, 2009

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Providing primary care physicians with an automated blood pressure machine and twice yearly education sessions on the application of hypertension treatment guidelines had no effect on the number of patients achieving blood pressure goals or whose hypertension was undiagnosed. This intervention also had no impact on the drugs chosen as the initial treatment, according to a study in the FebruaryAmerican Heart Journal (link).

"We need to start being creative and seeing what else we can do," said Denise Bonds, MD, MPH, lead author and an internist. The paper was submitted for publication when she was an associate professor at the University of Virginia in Charlottesville. She is now a medical officer at the National Heart, Lung and Blood Institute, although she was not speaking for the agency.

As part of the Guideline Adherence for Heart Health study, researchers randomized 61 primary care practices in North Carolina to receive academic detailing every six months on either the seventh edition of the guidelines from the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure; or the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. All practices received copies of the relevant guideline and feedback on their rates of adherence before the intervention. Equipment such as automatic blood pressure machines also were provided.

Despite these efforts, patients receiving care in practices targeted for the hypertension intervention were no more likely than those in the cholesterol guideline arm to achieve desired blood pressure or to receive a diagnosis if appropriate. There also was no statistically significant impact on systolic or diastolic blood pressure.

The authors suspect hypertension may get lost in the myriad issues to which primary care doctors attend. Also, previous papers have suggested patient involvement has a key role in achieving targets.

"Getting blood pressure control rates to improve will need more than just the physician," said Dr. Bonds. "It's really hard to be a primary care doctor. There are lots and lots of issues that are in front of you. Blood pressure is one of them, but it's not the only thing."

NHLBI funded this study, and a paper rounding up results from the cholesterol arm is expected soon.

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