Physician Adherence to Blood Pressure Guidelines and Its Effect on Seniors

• Published in: Pharmacotherapy 2008-07, Vol.28 (7), p.843-851
• Main Authors: Milchak, Jessica L., Carter, Barry L., Ardery, Gail, Dawson, Jeffrey D., Harmston, Matt, Franciscus, Carrie L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; blood pressure; Cardiology. Vascular system; explicit criteria; Female; Guideline Adherence; Humans; hypertension; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Practice Guidelines as Topic; quality of care; Retrospective Studies; seniors
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.28.7.843

Study Objective. To compare physician adherence to guidelines from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure for patients younger than 65 years of age with those aged 65 years and older, and to analyze whether factor groupings (subsets of criteria used to determine adherence) were predictive of blood pressure control. Design. Retrospective medical record review. Setting. Five university‐affiliated family medicine and internal medicine outpatient clinics. Patients. One hundred seventy‐nine patients (age range 21–85 yrs) with uncontrolled hypertension: 105 patients were younger than 65 years (nonsenior), and 74 patients were 65 years or older (senior). Measurements and Main Results. Data ed from each patient's medical record were used to evaluate adherence to 17 process‐of‐care criteria, identified to assess physician adherence to the guidelines. A computer algorithm generated scores for each criterion as well as an overall adherence score. The relationship between the adherence score and blood pressure control was then examined. Separate factor analyses were conducted to ascertain differences in the way that the criteria were grouped. Factor scores were calculated for each patient, and the scores were evaluated in the context of blood pressure control. Guideline adherence scores were significantly higher for nonsenior patients than for senior patients (59.3% vs 56.1%, p=0.024). Blood pressure control rate was also higher, although not significantly, in nonseniors versus seniors (68.6% vs 56.8%, p=0.063). No factors in the senior group were significantly associated with blood pressure control, but one was significantly correlated in the nonsenior group (p