O43 ADHERENCE OF CLINICIANS TO HYPERTENSION CLINICAL PRACTICE GUIDELINES: A MULTICENTER CROSS SECTIONAL STUDY

Background: Hypertension is the cardiovascular risk factor that accounts for most preventable deaths worldwide. Implementation of clinical practice guidelines (CPG) reduces variability in care and improves outcomes. In Colombia, clinicians’ adherence to recommendations is rarely reported. The aim of this study was to assess the adherence of clinicians to hypertension CPG in out-patient clinics from Bogotá. Methods: we performed a cross-sectional study as part of the baseline measurement of a cluster randomized trial. A panel of experts selected seven prioritized recommendations from the Colombian hypertension CPG. Clinicians from 5 health-care institutions in Bogotá, Colombia, who voluntarily accepted to participate were included. We consulted electronic health-records of a consecutive sample of patients with hypertension treated by the participating clinicians to evaluate the applicability of, and adherence to, selected recommendations. Results: The 37 clinicians included had a mean age of 36.9 years, 54.05% were male, most of them general physicians (83.7%) and the mean clinical experience was 10.5 years. Evaluation of 4872 recommendations by reviewing health-records from 696 patients (67% female, mean age 68.5 years, 51.5% less than 5 years since diagnosis) showed an overall applicability of 21.3% (CI95% 20.1-22.4%) and adherence was 29.1% (CI95% 26.3-37.9%). We identified a significant variation in adherence between recommendations, being highest for treating with combination of antihypertensive medications for stage 2 hypertension (58.7%) and lowest for proteinuria screening (7.8%) (figure 1). Adherence was better in male clinicians (25% vs 32%, p=0.008) and those with more clinical experience (35% for >10 years of experience vs 26% for <10 years of experience, p=0.014). Also, clinicians were more adherent to recommendations related to treatment with moderate certainty of evidence (39.5%), compared to those on screening with high certainty (15.2%). Conclusions: in a sample of physicians practicing in Bogotá, adherence to strong recommendations from the Colombian hypertension CPG varied greatly by clinicians’ sex, clinical experience and the type of recommendations, and was overall poor.