Explicit and implicit evaluation of physician adherence to hypertension guidelines.
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.
Ardery
Gail
G
The University of Iowa College of Pharmacy, Iowa City, IA 52242-1112, USA.
Carter
Barry L
BL
Milchak
Jessica L
JL
Bergus
George R
GR
Dawson
Jeffrey D
JD
James
Paul A
PA
Franciscus
Carrie
C
Kim
Yoonsang
Y
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