title: Doctors, nurses, pharmacists and patients--the Rational Evaluation and Choice in Hypertension (REACH) survey of hypertension care delivery.
abstract: Despite ongoing efforts by the medical profession, many hypertensive patients either refuse treatment or have blood pressures that are not adequately controlled. A key reason is likely to be the side effects of many antihypertensive drugs. We have investigated further reasons for stopping or altering antihypertensive treatment, and the patterns of prescribing in Britain by mounting a series of surveys amongst family doctors, practice nurses and their patients with hypertension. A total of 178 GPs and 158 practice nurses provided completed replies suitable for analysis. In addition, 948 patients were surveyed via their GP and 1167 were surveyed via their local pharmacist (600 unprompted, 567 prompted). Thirty-two percent of GPs stated that hypertensive patients generally consulted because they were experiencing drug side effects and 42% of all switches of drug therapy occurred because patients experienced side effects. The GPs perceived that 18% of their hypertensive patients did not comply with the antihypertensive therapy, and, of non-compliant patients, 22% were not complying due to drug side effects. The 158 practice nurses reported that 29% of patients they saw discussed drug side effects. Hypertensive patients were more likely to discuss the side effects of their antihypertensive treatments with the practice nurse than their doctor. Forty-six percent of 948 patients who were surveyed via their GP did not know what antihypertensive drug class they were taking. The most frequently mentioned reason for patients changing medication was drug side effects (42%) or lack of efficacy (39%). Fifty-nine percent of patients had never asked about possible side effects, but 34% reported that they had experienced unacceptable side effects. With some prompting by pharmacists, many hypertensive patients would discuss their antihypertensive drugs and any side effects. This survey highlights the lack of communication about potential side effects between the doctor and hypertensive patient, and the important role of the practice nurse. Our survey also shows that hypertension is not being managed as effectively as it could be and GPs appear to be spending the majority of their consulting time discussing and dealing with the side effects of treatment. This, therefore, suggests that drugs with a cleaner side effect profile could save valuable GP time and resources. Better communication with patients about side effects is, therefore, likely to improve compliance with hypertensive treatment.
authors.affiliation: University Department of Medicine, City Hospital, Birmingham, United Kingdom.
authors.forename: G Y
authors.initials: GY
authors.lastname: Lip
authors.forename: D G
authors.initials: DG
authors.lastname: Beevers
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D009726:Nurses; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D017060:Patient Satisfaction; D010361:Patients; D010595:Pharmacists; D010820:Physicians; D018434:Sickness Impact Profile
chemical_list: D000959:Antihypertensive Agents