Knowledge and acceptance of hypertension guidelines in clinical practice: Experience from Slovenia

Abstract

Arterial hypertension, which is an important risk factor for cardiovascular disease, is mainly treated by general practitioners. The initial step in an optimal therapeutic strategy for patients with arterial hypertension is the recognition and acceptance of hypertension guidelines by the physicians themselves. To find out how well Slovene general practitioners know the current hypertension guidelines and to what extent they accept them. Knowledge of current recommendations in hypertension diagnosis, treatment, follow-up and special indications was assessed for 813 general practitioners in Slovenia using a questionnaire. The Slovene National Guidelines were taken as the reference standard. Adequate knowledge of the guidelines' recommendations was defined as correct answers to at least seven out of eleven items; the correct answers had to include the appropriate target blood pressure, the elements of the "minimal diagnostic program" in hypertension and the correct estimation of cardiovascular risk. Acceptance of the guidelines was estimated on a five-grade scale: 5 meaning very useful, 1 meaning useless. A total of 321 questionnaires were suitable for analysis from 327 that were returned (a response rate of 40.2%). The mean number of correct answers was 7.8 (SD, 1.8, range, 4-11), but only 124 (38.8%) of the participating physicians answered the three key questions correctly. The physicians who answered the key questions correctly also answered more of the other questions correctly (6.1 vs. 5.4, p < 0.001). Adequate knowledge of the guidelines was found in 116 (36.8%) of the total study population; mean score for acceptance on the five-grade scale was 4.25. Knowledge of the guidelines was influenced by the physicians' acceptance of the guidelines' recommendations (p = 0.024). No other characteristics of physicians or organizational factors influencing knowledge of the guidelines were identified. Most of the participating physicians (72%) were willing to attend a workshop on managing hypertension and there was no connection between knowledge of the guidelines and willingness to attend the workshop. Knowledge of the hypertension guidelines among Slovene general practitioners is limited, and is comparable to the results of similar studies. The physicians' acceptance of the guidelines is high and correlates with their knowledge of the guidelines. A workshop is an accepted form of continuing medical education among general practitioners.