Abstract
BackgroundThe Hong Kong Government released a Reference Framework (RF-HT) for Hypertension Care for Adults in Primary Care Settings since 2010. No studies have evaluated its adoption by primary care physicians (PCPs) since its release.AimWe aimed to evaluate the level of PCPs’ adoption of the RF-HT and the potential barriers of its use in family practice.Design and settingA cross-sectional study was conducted by a self-administered validated survey among all PCPs in Hong Kong through various means.MethodsWe assessed the level of and factors associated with its adoption by multivariate logistic regression modelling.ResultA total of 3,857 invitation episodes were sent to 2,297 PCPs in 2014–2015. We received 383 completed questionnaires. The average score of adoption was 3.43 out of 4.00, and 47.5% of PCPs highly adopted RF-HT in their daily consultations. Male practitioners (adjusted odds ratio [aOR] = 0.524, 95% CI = 0.290–0.948, p = 0.033) and PCPs of public sector (aOR = 0.524, 95% CI = 0.292–0.940, p = 0.030) were significantly less likely to adopt the RF-HT. PCPs with higher training completion or being academic fellow are more likely to adopt RF-HT than those who were “nil to basic training completion” (aOR = 0.479, 95% CI = 0.269–0.853, p = 0.012) or “higher trainee” (aOR = 0.302, 95% CI = 0.093–0.979, p = 0.046). Three most-supported suggestions on RF-HT improvement were simplification of RF-HT, provision of pocket version and promoting in patients.ConclusionAmong PCP respondents, the adoption level of the RF-HT was high. These findings also highlighted some factors associated with its adoption that could inform targeted interventions for enhancing its use in clinical practice.
Highlights
Worldwide, hypertension accounts for 7.6 million premature deaths and 92 million disabilityadjusted life years (DALY) annually, and contributes to 47% of ischemic heart disease and 54% of stroke [1]
Studies reported that non-adherence to the guidelines would lead to wrong posture or positioning of patients while blood pressure was taken[11, 12], omission of cardiovascular disease (CVD) risk estimation [9, 13,14,15], under or over treatment [6, 14, 15], poor documentation [16] and lack of recommendations on lifestyle modification provided to patients [6, 16, 17]
The reference framework was the first standardized local hypertension guidelines made for the whole healthcare system in Hong Kong, providing general references for practice in primary care settings to support the policy of promoting primary care
Summary
A total of 3,857 surveys with the individual informed consent files were sent out through various means including postage or fax-line or electronic web-based answering system (3,255), invitation in the clusters of Hospital Authority (370), on-site visit (85) and recruitment in CME luncheons in person (147). 383 surveys were returned by these means, giving a response rate of 9.9%. The recommendations from reference framework can be categorized in three parts, i.e. blood pressure measurement, lifestyle modification and drug treatment. 371 out of 383 physicians highly adopted the reference framework to initiate drug treatment when patient’s blood pressure is greater than 160 mmHg after undergoing lifestyle modification (S1 Table). Potential factors associated with reference framework adoption were divided to four themes, including guideline-related, patient-related, PCP-related and external factors. G. Advise hypertensive patients to maintain optimal body weight and adopt healthy eating habit. M. Increase dosage or adding third drug from different class if BP goal was not reached after primary treatment in hypertensive patients. Suggestions to further improve the adoption level of reference framework among doctors were shown in Table 5, i.e. simplification of RF-HT (91.9%), provision of pocket versions (86.4%) and RF-HT promotion in patients in a patient-centered manner (81.9%)
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