Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia.
OBJECTIVE
To monitor changes in family physicians' reported practice on hypertension and hypercholesterolaemia.


METHODS
Random samples of physicians were selected for telephone interviews on their practice regarding cut-off levels and pharmacological treatment of hypertension and hypercholesterolaemia, related to a case scenario of a 48-year-old man, in 1989, 1991 and 1993.


METHODS
Primary care facilities in southern Sweden.


METHODS
Specialists in family medicine, employed in public primary health care. Participation rates were in 187/201 (93%) in 1989, 236/264 (89%) in 1991 and 257/298 (86%) in 1993.


METHODS
Cut-off levels and drug treatment preferences for hypertension and hypercholesterolaemia.


RESULTS
During the period 1989-1993, decreasing mean cut-off levels for pharmacological treatment of hypertension (P < 0.001) were reported, below the levels of the guidelines. Although betablockers were first choice drug in all three surveys, the proportion preferring this has diminished (P < 0.001), whilst the proportions preferring ACE-inhibitors and calcium channel blockers have increased (P < 0.001 and P = 0.02, respectively). For drug treatment of hypercholesterolaemia, the mean cut-off level remained close to guidelines in all three surveys. The proportion of physicians suggesting resins and nicotinic acid as first choice drug had decreased (P < 0.001 and P = 0.03, respectively), whilst the proportion preferring statins and fibrates had increased (P < 0.001 and P = 0.048, respectively).


CONCLUSIONS
Practice guidelines on hypertension and hypercholesterolaemia have not had the desired impact on physicians' reported practice. The reason for this might be that physicians did not value the guidelines as adequate tools for practice, or that the methods for dissemination, implementation, and maintenance of guidelines were not appropriate.
Troein
M
M
Department of Community Medicine, Lund University, Malmö, Sweden.
Gardell
B
B
Selander
S
S
Råstam
L
L
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D013548:Sweden
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D002784:Cholesterol