title: Diuretics for hypertension-reasons for a contradiction in primary care prescribing behavior: a qualitative study.
abstract: There has been a long international discussion on diuretics as first-line therapy for hypertension. In Germany, thiazide diuretics are very rarely prescribed in monotherapy and concurrently highly prescribed in fixed-combinations. The aim of this study was to approach the reasons for this inconsistency in primary care prescribing behavior. A qualitative study design consisting of single interviews with general practitioners (GPs) was chosen. Most GPs perceived diuretics as too weak to treat arterial hypertension effectively in monotherapy. In combination therapy, GPs expected to spare the dose and to offset certain side effects of other drugs. The convenient availability of diuretics in most fixed-dose combinations on the German drug market was seen as an important reason for their frequent prescription in combination therapy. Thus, the reasons given by the GPs differed from the main arguments of the academic debate. Dissemination strategies for guidelines should take the perceptions and opinions of practicing GPs into account.
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany. henrik.lamers@med.uni-heidelberg.de
authors.forename: Henrik
authors.initials: H
authors.lastname: Lamers
authors.forename: Stefanie
authors.initials: S
authors.lastname: Joos
authors.forename: Katja
authors.initials: K
authors.lastname: Goetz
authors.forename: Katja
authors.initials: K
authors.lastname: Hermann
authors.forename: Joachim
authors.initials: J
authors.lastname: Szecsenyi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kühlein
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D058005:General Practitioners; D005858:Germany; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors