The competence of primary care doctors in the investigation of patients with elevated blood pressure: results of a cross-sectional study using clinical vignettes.
BACKGROUND
Specific laboratory tests are required to ensure adequate management of patients with hypertension, according to internationally accepted guidelines. There is wide variation in doctor test ordering behaviour. Many factors are known to affect this. Little is known about the interaction between doctor, patient and practice characteristics. The current study was designed to explore this.


METHODS
A series of eight case vignettes was designed to examine test ordering behaviour among primary care doctors in Poland. The cases differed with regard to the level of blood pressure and the presence or absence of other cardiovascular risk factors, including diabetes. Doctors stated their choices of laboratory investigations needed in these cases. Their responses were compared with recommendations in the 2003 European Society of Hypertension/European Society of Cardiology hypertension guidelines. Associations between the correct responses and patient, doctor and practice characteristics were tested.


RESULTS
One hundred and twenty-five out of 192 invited doctors (65%) participated in the study. They ordered a mean of 4.9 laboratory tests per case. This represents 47.9% of the tests recommended by current guidelines. Older doctors working in smaller practices and private settings ordered fewer laboratory tests. Specialization in family medicine was associated with greater compliance with guidelines. Grade 2 hypertension and the presence of other risk factors of cardiovascular disease were associated with ordering more tests but the presence of diabetes did not improve compliance with guidelines.


CONCLUSIONS
Further educational efforts are needed to promote rational test ordering for hypertensive patients by Polish primary health care doctors.
Windak
Adam
A
Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland. mmwindak@cyf-kr.edu.pl
Gryglewska
Barbara
B
Tomasik
Tomasz
T
Narkiewicz
Krzysztof
K
Yaphe
John
J
Grodzicki
Tomasz
T
D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D011044:Poland; D010818:Practice Patterns, Physicians'