Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

ABSTRACT

Background: Clinical guidelines are systematically developed statements that assist practitioners and patients to make healthcare decisions for specific clinical circumstances. Non-adherence of doctors to guidelines is thought to contribute significantly to poor delivery of clinical care; resulting in poor clinical outcomes. Aim: To investigate adherence of doctors in rural district hospitals to clinical guidelines using the South African Hypertension Guideline 2006 as an example.Setting: Four district hospitals in Bojanala district of North-West Province; South Africa.Methods:A cross-sectional study determined adherence practices of doctors from records of patients with established hypertension seen at the four district hospitals.Results: Of the 490 total records documented by 29 doctors; screening for co-morbidity or associated factors was carried out as follows diabetes mellitus 99.2%; obesity 6.1%; smoking 53.5%; dyslipidaemia 36.9%; abdominal circumference 3.3%; organ damage eye 0; kidney 82%; heart 43.5%; chronic kidney disease 38.2%; stroke/transient ischaemic attack 15.9%; heart failure 23.5%; advanced retinopathy 0.2%; coronary heart disease 23.7%; peripheral arterial disease 13.9%. Critical tests/measurements were documented in the following proportions blood pressure 99.8%; weight 85.3%; height 65.7%; body mass index 3.1%; urinalysis 74.5%; lipogram 76.1%; urea/creatinine 80.4%; electrocardiogram 42.9%; blood glucose 100%; risk determination and grading diagnosis by hypertension severity 19%; low added risk 57.1%; moderate added risk 64.7%; high added risk 89.6%; very high added risk 89.2%. Adherence to therapies was as follows first-line guideline drugs 69.4%; second line 84.7%; third line 87.8% and fourth-line 89.6%.Conclusion: Overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). Low adherence rates were related to age (older doctors) and less clinical experience; and differed with regard to various aspects of the guidelines