Awareness and implementation of hypertension guidelines in primary health care in Kuwait

ABSTRACT

World Health Organization / International Society of Hypertension [WHO/ISH] guideline makes recommendations on primary care management of hypertension. Hypertension control is based on physician awareness and familiarity with these guidelines and their attitudes in clinical practice. This study aimed to evaluate primary health care [PHC] physicians' awareness and attitude towards WHO / ISH guidelines for management of hypertensive patients, and their opinions regarding barriers for implementation of these guidelines. The study is a cross-sectional survey that was conducted from September to October 2008. Self-administered questionnaires were distributed to all physicians currently working in all PHC centers in the five health regions in Kuwait. The questionnaire included data about personal characteristics, level of knowledge and agreement with [WHO / ISH] guidelines as well as implementation of the guidelines and questions related to barriers to improve their hypertensive patient management. Although most physicians [90.7%] were familiar with the new WHO / ISH guidelines. 83.4% of them were in agreement with. Also, it was found that only 26.7% always follow these guidelines, 56.7% sometimes follow them. The median value of the correct answers was 5 from 10 statement with a range from zero to 9. About one fifth of the physicians [20.5%] could not attain 5/10 score, and none chose correctly the 10 correct statements. Results suggest that participants, in their clinical practice, accept higher BP levels than recommnended in clinical practice. Also, they tend to give more attention for hypertensive patients with co-morbidity. The most important barriers for improvement of hypertension control, that physicians stated, were lack of time, non availability of the drugs in the clinic, lake of patient knowledge, poor patient compliance to life style modifications, non adherence of patients to their medications, and follow up by different physicians. The results of this survey indicate that there is an urge tit need to establish nationwide educational and quality monitoring programs to facilitate the implementation of new hypertension guidelines vi PHC clinical practices in Kuwait