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BMC Family Practice

, 12:87

Service organization, utilization, and delivery of care


BackgroundAntihypertensive drug choices and treatment levels are not in accordance with the existing guidelines. We aimed to assess the impact of a guideline implementation intervention on antihypertensive drug prescribing.

MethodsIn this controlled before and after study, the effects of a multifaceted education, audit and feedback, local care pathway quality programme was evaluated. The intervention was carried out in a health centre between 2002 and 2003. From each health care unit n = 31, a doctor-nurse pair was trained to act as peer facilitators in the intervention.

All antihypertensive drugs prescribed by 25 facilitator general practitioners intervention GPs and 53 control GPs were retrieved from the nationwide Prescription Register for three-month periods in 2001 and 2003. The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes.

ResultsIn all subgroups, the use of multiple concurrent medications increased. For intervention patients with hypertension only, the odds ratio OR was 1.12 95% CI 0.99, 1.25; p = 0.06 and for controls 1.13 1.05, 1.21; p = 0.002. We observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups. The use of agents acting on the renin-angiotensin-aldosterone system increased in all subgroups hypertension only intervention patients OR 1.19 1.06, 1.34; p = 0.004 and controls OR 1.24 1.15, 1.34; p < 0.0001.

ConclusionsA multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2296-12-87 contains supplementary material, which is available to authorized users.

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Autor: Raija Sipilä - Arja Helin-Salmivaara - Maarit Jaana Korhonen - Eeva Ketola


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