Healthy Skepticism Library item: 2275

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Publication type: Journal Article

Adair R, Callies L, Lageson J, Hanzel KL, Streitz SM, Gantert SC.
Posting guidelines: a practical and effective way to promote appropriate hypertension treatment.
Jt Comm J Qual Patient Saf 2005 Apr; 31:(4):227-32
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

Abstract:

BACKGROUND: Despite publication and periodic updating of treatment guidelines, hypertension remains undertreated in the United States, and physicians underuse recommended drugs.

METHODS: Hypertension treatment guidelines were summarized and posted in five places in a hospital-based primary care clinic staffed by internists and internal medicine residents. Costs and recommended doses of five commonly used antihypertensive drugs were included. The charts of all 253 patients seen during a four-month period with a diagnosis of hypertension were analyzed. Blood pressures and physician prescribing habits were compared at baseline and at 8, 12, and 16 months after posting the guidelines.

RESULTS: The number of patients with blood pressures < 140/90 mm Hg increased from 41% to 58%, p = .001. Median (IQR) systolic pressure fell from 143 (119-167) to 137 (116-158) mm Hg, p < .0001 and diastolic pressure from 78 (65-91) to 77 (64-90) mm Hg, p = .0002. Physicians prescribed more recommended drugs, more total antihypertensive drugs, larger doses of hydrochlorothiazide and lisinopril, and more inexpensive drugs. The total cost of antihypertensive drugs per patient increased slightly.

CONCLUSION: Regular exposure to clinical guidelines, presented in a practical and simple way, can change physician behavior and improve patient care.

Keywords:
MeSH Terms: Adult Aged Aged, 80 and over Ambulatory Care Facilities Antihypertensive Agents/therapeutic use Evidence-Based Medicine Female Humans Hypertension/drug therapy* Male Middle Aged Minnesota Physician's Practice Patterns Practice Guidelines/standards* Quality Assurance, Health Care/methods