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      Adherence of General Practitioners to the National Hypertension Guideline, Isfahan, Iran

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          Abstract

          Background:

          High systolic blood pressure is the leading risk factor for global mortality. Applying effective strategies to control hypertension is a rising concern. Guidelines are approved to be effective in the management of patients with cost-effective interventions. The aim of this study is to evaluate the adherence of family physicians working in Isfahan health centers to the national hypertension guideline, in 2019.

          Methods:

          Using a cross-sectional study, the practice of 43 physicians selected by a multistage sampling method from the perspective of hypertension management was observed in 377 visits. The data gathering form was designed according to the national hypertension guideline. Adherence to the guideline was evaluated by dividing the earned score by the most score one can earn. Data were analyzed using Independent T-test, Pearson correlation and linear regression model.

          Results:

          The mean score of adherence to the national hypertension guideline was 33.6 ± 16.42%. There was a significant association between physician's sex, years passed from graduation, type of occupation contract, type of university of education, and attending empowerment class and adherence to the national hypertension guideline.

          Conclusions:

          The results of our study show that family physicians just follow one-third of the recommendations in the national hypertension guideline.

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          Most cited references26

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          Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

          Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions.
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            Why don't physicians follow clinical practice guidelines? A framework for improvement.

            Despite wide promulgation, clinical practice guidelines have had limited effect on changing physician behavior. Little is known about the process and factors involved in changing physician practices in response to guidelines. To review barriers to physician adherence to clinical practice guidelines. We searched the MEDLINE, Educational Resources Information Center (ERIC), and HealthSTAR databases (January 1966 to January 1998); bibliographies; textbooks on health behavior or public health; and references supplied by experts to find English-language article titles that describe barriers to guideline adherence. Of 5658 articles initially identified, we selected 76 published studies describing at least 1 barrier to adherence to clinical practice guidelines, practice parameters, clinical policies, or national consensus statements. One investigator screened titles to identify candidate articles, then 2 investigators independently reviewed the texts to exclude articles that did not match the criteria. Differences were resolved by consensus with a third investigator. Two investigators organized barriers to adherence into a framework according to their effect on physician knowledge, attitudes, or behavior. This organization was validated by 3 additional investigators. The 76 articles included 120 different surveys investigating 293 potential barriers to physician guideline adherence, including awareness (n = 46), familiarity(n = 31), agreement (n = 33), self-efficacy (n = 19), outcome expectancy (n = 8), ability to overcome the inertia of previous practice (n = 14), and absence of external barriers to perform recommendations (n = 34). The majority of surveys (70 [58%] of 120) examined only 1 type of barrier. Studies on improving physician guideline adherence may not be generalizable, since barriers in one setting may not be present in another. Our review offers a differential diagnosis for why physicians do not follow practice guidelines, as well as a rational approach toward improving guideline adherence and a framework for future research.
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              Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.

              Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown.
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                Author and article information

                Journal
                Int J Prev Med
                Int J Prev Med
                IJPVM
                International Journal of Preventive Medicine
                Wolters Kluwer - Medknow (India )
                2008-7802
                2008-8213
                2020
                19 August 2020
                : 11
                : 130
                Affiliations
                [1] Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
                Author notes
                Address for correspondence: Dr. Atefeh Vaezi, Department of Community and Family Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail: Atefehvaezi83@ 123456gmail.com
                Article
                IJPVM-11-130
                10.4103/ijpvm.IJPVM_379_19
                7554564
                33088458
                ab7e8719-1e20-430c-a120-27002796572f
                Copyright: © 2020 International Journal of Preventive Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 16 October 2019
                : 08 January 2020
                Categories
                Original Article

                Health & Social care
                family,guideline,guideline adherence,hypertension,iran,physicians
                Health & Social care
                family, guideline, guideline adherence, hypertension, iran, physicians

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