title: Explicit and implicit evaluation of physician adherence to hypertension guidelines.
abstract: This study evaluated physician adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) hypertension guidelines in 6 community-based clinics. Explicit review of retrospective medical record data for patients with uncontrolled hypertension measured guideline adherence using 22 criteria. Mean overall guideline adherence was 53.5% and did not improve significantly over time. Random-effects models demonstrated significant associations between guideline adherence and various demographic and medical predictors, including age, minority status, comorbid conditions, and number of medications. A subsequent implicit review evaluated the degree to which nonadherence was justifiable and identified factors that might have affected adherence. Nonadherence was rated as justifiable for only 6.6% of the failed explicit criteria. In general, adherence to the JNC 7 guidelines was modest even when barriers that might have affected adherence were taken into consideration.
authors.affiliation: The University of Iowa College of Pharmacy, Iowa City, IA 52242-1112, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Ardery
authors.forename: Barry L
authors.initials: BL
authors.lastname: Carter
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Milchak
authors.forename: George R
authors.initials: GR
authors.lastname: Bergus
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Dawson
authors.forename: Paul A
authors.initials: PA
authors.lastname: James
authors.forename: Carrie
authors.initials: C
authors.lastname: Franciscus
authors.forename: Yoonsang
authors.initials: Y
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006764:Hospitals, Community; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007484:Iowa; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D017410:Practice Guidelines as Topic