0107750D
Masters Research - Faculty of Health sciences / The prescription habits of general practitioners are continually under the scrutiny of
ethical critics. There are numerous factors that influence a practitioner’s decision as to
which antihypertensive agents to prescribe for the treatment of hypertension. As
outlined in various international and national guidelines for the management of
hypertension, the recommended treatment depends on ethnicity, current life-style,
diet, smoking, age, gender, family history and possible underlying or secondary
conditions such as diabetes mellitus, heart failure, isolated systolic hypertension,
myocardial infarction, pregnancy, and evidence of coronary artery disease (CAD),
stroke or peripheral vascular disease.
Currently the control of blood pressure in patients with hypertension is far from
optimal with over 70% of hypertensive patients being reported as having imperfect
control. A number of factors related to the patient, the practitioner or the medication
may explain the high incidence of inadequate blood pressure control. One possible
explanation for the poor control of blood pressure may be that practitioners fail to
comply with the guidelines.
Hence the aim of my study was firstly to determine whether a practitioner’s decision
as to which medication to prescribe in the treatment of hypertension is influenced by
the Southern African Hypertension Society Guidelines. Secondly, in an attempt to
assess the validity of the results of the primary analysis, the actual prescription habits
(MediCross® database) were assessed and compared to the general practitioner’s
recall of their prescription habits.
Questionnaires were distributed to 320 MediCross® practitioners and prescription
habits were identified and substantiated by the screening of an existing MediCross®
database. I chose as my sample MediCross® general practitioners, as they are
demographically representative of all major urban areas in South Africa; likely to be
open-minded to supporting research and answering questionnaires (as MediCross® is
part of a Clinical Research Site Management Organisation); and I had access to the
database of the prescriptions made by MediCross® practitioners hence enabling me to
fulfil my second objective. However, it must be kept in mind that these practitioners
are representative of general practitioners in urban areas only (as the title of my
research report indicates).
My results show that 33.1% adhere to the guidelines (when a non-conservative
definition of diuretics is used); 27% have heard of the guidelines and have a copy of
them. When asked to give their own opinion however, 39% thought they adhered to
the guidelines. The results also show that ACE inhibitors are the most commonly
prescribed drug class for uncomplicated hypertension but a comparison to a
MediCross® database, of which the quality is questionable, does not support this.
As the response rate to the questionnaires was only 24.7%, these results are only a
pilot study; however they suggest that few general practitioners use the guidelines or
even have a copy of the guidelines. This pilot study suggests that the guidelines need
to be distributed more widely. Furthermore the general practitioners that responded to
the questionnaire indicated that the management of hypertension is difficult in that
there is no single treatment regimen appropriate for all populations and each different
- 5 -
patient. It was also their view that clinical guidelines for the management of
hypertension should more accurately reflect the uncertainty of when to initiate
treatment and individual variation if they are going to take these guidelines seriously
and comply with them.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/1429 |
| Date | 25 October 2006 |
| Creators | Van Niekerk, Diederik Johannes |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | 207839 bytes, application/pdf, application/pdf |
Page generated in 0.009 seconds