Factors influencing family physician adherence to hypertension treatment guideline recommendations on the initiation of pharmacotherapy: questionnaire survey

Background: Family physicians do not prescribe antihypertensive medication according to current guidelines. This study investigates possible reasons for this. The objectives were to measure the knowledge, attitude and stated practice of family physicians to the initiation of pharmacotherapy for uncomplicated hypertension and to explore the reasons why clinical practice differs from guideline recommendations. Study design: A cross-sectional postal survey conducted between June and October 1999. Simple frequency analysis and a χ2 test comparing family physician characteristics and responses. Methods: A three-phase postal survey was undertaken of a random sample of family physicians. Telephone and facsimile contact was made to non-responders. The survey instrument included respondent characteristics, preference for initiation of antihypertensive drug therapy and their opinion of efficacy, adverse effects and long-term safety, as well as knowledge of guidelines. Participants: Family physicians in the state of Victoria, Australia. Main outcome measures and results: Ranked preference of drugs for uncomplicated hypertension. Opinion of drug efficacy, adverse effects, safety and cost. Knowledge of guidelines for first-line antihypertensive drugs. Newer agents are preferred to older agents in the initiation of antihypertensive drug therapy contrary to current guideline recommendations. Newer agents were thought to be more efficacious, have better short- and long-term adverse effect profiles and be more expensive than older agents. Younger doctors most often held these attitudes. Guidelines influenced decision making but were not the most important factor. Conclusions: There is a demonstrable need for governments to invest in the promotion of accurate information on drugs through continuing education of prescribers and facilitating the production of standardized paper and web-based clinical guidelines. A program of targeted investment in clinical trials that examine the justification for more expensive classes of agents should also be considered in appropriate circumstances.