title: Hypertension guideline recommendations in general practice: awareness, agreement, adoption, and adherence.
abstract: BACKGROUND
  GPs vary greatly in their clinical management of hypertension, for reasons that are poorly understood.
  
  
  OBJECTIVE
  To explore GPs' awareness of current hypertension guidelines and their self-reported implementation of them in clinical practice.
  
  
  METHODS
  Questionnaire survey via the internet.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  Survey of GPs (n = 401), based on the 'awareness-to-adherence' model of behavioural change.
  
  
  RESULTS
  While awareness of recommendations was high, agreement and adoption were often less so. Almost all practitioners (99%) were aware of the guidance on statin therapy but fewer than half (43%; 95% confidence interval [CI] 38-48%) adhered to the recommendation in practice. Three-quarters (77%) were aware that blood pressure should initially be measured in both arms, but only 30% agreed with the recommendation (95% CI = 26 to 34%), and 13% (95% CI = 10 to 16%) adhered to it. Although the adoption of a recommendation was usually consequent on agreement with it, 19% of GPs (95% CI = 15 to 23%) reported adherence to financially incentivised guidance on statin therapy without either being aware of it or in agreement with it. No significant association was found among age, sex, year of graduation, or post held and level of awareness, agreement, or adoption.
  
  
  CONCLUSIONS
  The specific barrier and action needed to promote application of hypertension guidelines varies with each clinical action. Lack of awareness is seldom the problem. Most GPs are unlikely to implement elements of guidance they disagree with even if given financial incentives. High adherence requires a reflective workforce that can respond to the scientific evidence underpinning the guidance.
authors.affiliation: Department of Primary Health Care, Centre for Evidence-Based Medicine, University of Oxford. carl.heneghan@dphpc.ox.ac.uk
authors.forename: Carl
authors.initials: C
authors.lastname: Heneghan
authors.forename: Rafael
authors.initials: R
authors.lastname: Perera
authors.forename: David
authors.initials: D
authors.lastname: Mant
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
mesh_terms: D001291:Attitude of Health Personnel; D001795:Blood Pressure Determination; D002983:Clinical Competence / Q000592:standards; D005194:Family Practice / Q000191:economics / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006306:Health Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D006973:Hypertension / Q000191:economics / Q000628:therapy*; D020407:Internet; D008019:Life Style; D008297:Male; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards*; D011795:Surveys and Questionnaires
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors