Gap between guideline and real primary practice : treatment in patients with hypertension

Lee, Kwang No; Park, Chang Gyu; Choi, Cheol Ung; Lim, Hong Euy; Kim, Eung Ju; Rha, Seung Woon; Seo, Hong Seog; Oh, Dong Joo; Park, Jeong Bae

Abstract

BACKGROUND
In this study, we investigated the gap between treatment guidelines for hypertension and the actual treatment attitude of patients and doctors in actual practice.
METHODS
Participants in this study were 100 primary care physicians and 200 hypertensive patients. We used a questionnaire that included baseline characteristics about monitoring blood pressure, medical treatment and lifestyle modification, and analysis based on the '2004 Korean Hypertension Guidelines'
RESULTS
There were four deviations from the guidelines. First, fewer than 30% of physicians followed the guidelines for blood pressure measurement. Second, 34% patients responded that they were not informed of the target blood pressure by their physician. Among the informed patients, 20% did not remember the target blood pressure. Third, there was a difference between physician and patient regarding recognition of drug compliance. Most patients recognized that they were compliant with their medicine dosage but only 30% of physicians did, nor did the physicians recognize that in 30% of patients blood pressure was not controlled because of poor compliance. Fourth, 90% of patients at the initial diagnosis received information regarding lifestyle modification. But it was just a recommendation and not a prescription.
CONCLUSION
There are significant gaps between treatment guidelines for hypertension and actual treatment status in actual primary practice. A better understanding of the guidelines is needed to improve this implementation gap.