Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Hypertension | Research article

Adherence of doctors to hypertension clinical guidelines in academy charity teaching hospital, Khartoum, Sudan

Authors: Hiba Salah Abdelgadir, Maisa Mustafa Elfadul, Nisreen Haider Hamid, Mounkaila Noma

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

Clinical guidelines are systematically proven statements that help physicians to make healthcare decisions for specific medical conditions. Non-adherence to clinical guidelines is believed to contribute significantly to poor delivery of clinical care, and hence poor clinical outcomes. This study aimed at investigating adherence of doctors to hypertension clinical guidelines in Academy Charity Teaching Hospital, Khartoum, Sudan.

Methods

A cross-sectional hospital-based study was conducted during the period from January 2017 to October 2017 on a sample of 150 doctors. Adherence of doctors to hypertension guidelines was measured through the modified JNC7 adherence tool. Descriptive statistics was used to summarize the data (mean, standard deviation, median) and analyzed by frequency tables. Chi square test used to determine association among categorized variables. Logistic regression analysis was conducted to determine the relation between adherence to hypertension guidelines and the explanatory variables. All statistical tests were considered statistically significant when p value < 0.05.

Results

Of the 150 participants, 92% (138/150) were aware of the major hypertension treatment guidelines. 71% (98/138) reported the use of guidelines recommendations in their practice. Whereas 52% (78/150) were aware of local Sudanese guidelines. High adherence rate was highly statistically associated with job titles (p = 0.000), and also associated with age of the participants (p = 0.024) and duration of clinical experience (p = 0.012). However, the logistic regression analysis revealed despite all those variables were contributing to adherence to the treatment guidelines, only duration of clinical experience was statistically significant (p = 0.022).

Conclusion

The overall adherence of doctors to hypertension treatment guidelines was very low. This study highlights how a gap in clinical governance contributes to low adherence to clinical guidelines. Establishing regular clinical audit, issuing regulations to enforce the use of updated guidelines, along with introducing training programs in hospitals and continuous assessment to the practicing doctors are suggested as crucial interventions. Considerable efforts to build clinical governance in Sudan are required.
Literature
1.
2.
Feng XL, Pang M, Beard J. Health system strengthening and hypertension awareness, treatment and control: data from the China health and retirement longitudinal study. Bull World Health Organ. 2013;92:29–41.PubMedPubMedCentralCrossRef
3.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). Jama. 2014;311(5):507–20.PubMedCrossRef
4.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. lancet. 2012;380(9859):2224–60.PubMedPubMedCentralCrossRef
5.
Elfaki BA, Mustafa HE, Elnimeiri MK. Prevalence and awareness of hypertension among Sudanese rural population, Sinnar state, Sudan, 2016. J Nurs Educ Pract. 2017;7(6):1.CrossRef
6.
Magobe NB, Poggenpoel M, Myburgh C. Experiences of patients with hypertension at primary health care in facilitating own lifestyle change of regular physical exercise. Curationis. 2017;40(1):1–7.CrossRef
7.
Bushara SO, Noor SK, Ibraheem AAH, Elmadhoun WM, Ahmed MH. Prevalence of and risk factors for hypertension among urban communities of North Sudan: detecting a silent killer. J family med primary care. 2016;5(3):605.CrossRef
8.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Jama. 2003;289(19):2560–71.PubMedCrossRef
9.
Armstrong C. JNC8 guidelines for the management of hypertension in adults. Am Fam Physician. 2014;90(7):503–4.PubMed
10.
11.
Aboyans V, Ricco J-B, Bartelink M-LE, Björck M, Brodmann M, Cohnert T, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS) document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: the European stroke organization (ESO) the task force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2017;39(9):763–816.CrossRef
12.
Carey RM, Whelton PK. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association hypertension guideline. Ann Intern Med. 2018.
13.
Sudan Guidelines for the Managemet of Systematic Hypertention in Adults: Sudan Society of Hypertentsion and Non communicable Diseases Directorate; [cited 2017]. Second edition, September 2014:[Available from: http://​ssh-sd.​org/​guidelines/​. Accessed Aug 2017.
14.
Tesfaye F, Byass P, Wall S. Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic. BMC Cardiovasc Disord. 2009;9(1):39.PubMedPubMedCentralCrossRef
15.
Adedeji AR, Tumbo J, Govender I. Adherence of doctors to a clinical guideline for hypertension in Bojanala district, north-West Province, South Africa. Afr J Prim Health Care Fam Med. 2015;7(1):1–6.CrossRef
16.
Kotchen TA. The search for strategies to control hypertension. Am Heart Assoc. 2010.
17.
Cáceres León MC, Moyano López P, Fariñas Seijas H, Cobaleda Polo J, Pijierro Amador A, Dorado Hernández P, et al. Trends in antihypertensive drug use in Spanish primary health care (1990–2012). 2015.
18.
Xu H, He Y, Xu L, Yan X, Dai H. Trends and patterns of five antihypertensive drug classes between 2007 and 2012 in China using hospital prescription data. Int J Clin Pharmacol Ther. 2015;53(6):430–7.PubMedCrossRef
19.
Adejumo O, Okaka E, Iyawe I. Prescription pattern of antihypertensive medications and blood pressure control among hypertensive outpatients at the University of Benin Teaching Hospital in Benin City, Nigeria. Malawi Med J. 2017;29(2):113–7.PubMedPubMedCentralCrossRef
20.
Herd G, Musaad S. Clinical governance and point-of-care testing at health provider level. NZ Med J. 2015;128:41–6.
21.
Lawrenson R, Reid J, Nixon G, Laurenson A. The New Zealand rural hospital doctors workforce survey 2015. NZ Med J. 2016;129(1434):9–16.
22.
Gauld R, Horsburgh S. Healthcare professionals’ perceptions of clinical governance implementation: a qualitative New Zealand study of 3205 open-ended survey comments. BMJ Open. 2015;5(1):e006157.PubMedPubMedCentralCrossRef
23.
Mohaghegh B, Ravaghi H, Mannion R, Heidarpoor P, Sajadi HS. Implementing clinical governance in Iranian hospitals: purpose, process and pitfalls. Electron Physician. 2016;8(1):1796.PubMedPubMedCentralCrossRef
24.
Abdulameer SA, Sahib MN, Aziz NA, Hassan Y, AlRazzaq HAA, Ismail O. Physician adherence to hypertension treatment guidelines and drug acquisition costs of antihypertensive drugs at the cardiac clinic: a pilot study. Patient preference and adherence. 2012;6:101.PubMedPubMedCentralCrossRef
25.
Adhikari S, Mathiasen R, Lander L. Elevated blood pressure in the emergency department: lack of adherence to clinical practice guidelines. Blood pressure monitoring. 2016;21(1):54–8.PubMedCrossRef
26.
Milchak J, Carter B, Ardery G, Black H, Bakris G, Jones D, et al. Development of explicit criteria to measure adherence to hypertension guidelines. J Hum Hypertens. 2006;20(6):426.PubMedPubMedCentralCrossRef
27.
Barbouni A, Nalmpanti M, Gennimata D, Theodoridis D, Merakou K. Beliefs and practices of Greek doctors in relation to patients’ adherence to antihypertensive medication. J Hum Hypertens. 2017;31(5):341.PubMedCrossRef
28.
Theodorou M, Stafylas P, Kourlaba G, Kaitelidou D, Maniadakis N, Papademetriou V. Physicians’ perceptions and adherence to guidelines for the management of hypertension: a national, multicentre, prospective study. Int J Hypertens. 2012;2012.
29.
Ardery G, Carter BL, Milchak JL, Bergus GR, Dawson JD, James PA, et al. Explicit and implicit evaluation of physician adherence to hypertension guidelines. J Clin Hypertens. 2007;9(2):113–9.CrossRef
30.
Echlin PS, Upshur RE, Markova TP. Lack of chart reminder effectiveness on family medicine resident JNC-VI and NCEP III guideline knowledge and attitudes. BMC Fam Pract. 2004;5(1):14.PubMedPubMedCentralCrossRef
31.
Lugtenberg M, Zegers-van Schaick JM, Westert GP, Burgers JS. Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners. Implement Sci. 2009;4(1):54.PubMedPubMedCentralCrossRef
32.
McKinlay JB, Link CL, Freund KM, Marceau LD, O’Donnell AB, Lutfey K. Sources of variation in physician adherence with clinical guidelines: results from a factorial experiment. J Gen Intern Med. 2007;22(3):289–96.PubMedPubMedCentralCrossRef
Metadata
Title
Adherence of doctors to hypertension clinical guidelines in academy charity teaching hospital, Khartoum, Sudan
Authors
Hiba Salah Abdelgadir
Maisa Mustafa Elfadul
Nisreen Haider Hamid
Mounkaila Noma
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4140-z

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Research article

Evaluating the impact of the single exit price policy on a basket of originator medicines in South Africa from 1999 to 2014 using a time series analysis

Research article

Communicating prognosis to women with early breast cancer – overview of prediction tools and the development and pilot testing of a decision aid

Research article

“Five-year changes in population newborn health associated with new preventive services in targeted risk-group pregnancies”

Research article

Association between degree of exposure to the Hospital Value Based Purchasing Program and 30-day mortality: experience from the first four years of Medicare’s pay-for-performance program

Research article

Participation in the state led ‘Janani Sahayogi Yojana’ public private partnership program to promote facility births in Madhya Pradesh, India: views from private obstetrician partners

Research article

High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population