Assessment of knowledge, attitudes, and practices of primary healthcare physicians in provinces of Armenia towards hypertension management: a cross-sectional study

INTRODUCTION: Hypertension is the leading cause of death globally, yet little is known about how Armenian primary care providers (PCPs) manage the condition. This study assessed the knowledge, attitudes, practices, priorities, and confidence patterns of PCPs in Armenia towards hypertension management. METHODS: A population-specific proportional sampling was conducted through a cross-sectional survey among PCPs in all provinces of Armenia. A World Hypertension League questionnaire was adapted to follow the Armenian hypertension guidelines. The survey included the following domains: knowledge of Armenian guidelines, attitudes towards management, management practices, priority towards management, and confidence in clinical duties. For each domain, composite scores were calculated as the percentage of items answered correctly or desirably, and regression analyses were performed to examine factors associated with domain-level composite scores and selected individual survey items. RESULTS: The composite knowledge score of 46.4% (95% CI 45.0%-47.7%%) was suboptimal, despite awareness of hypertension as a priority (97.6%). Composite scores indicated moderate confidence (59.2%, 95% CI 55.1%-63.4%), positive attitude (53.6%, 95% CI 51.4%-55.7%), strong practice (75.2%, 95% CI 74.6%-75.9%), and a high priority (93.1%, 95% CI 92.2%-94.0%). About 45% (n = 152) of PCPs adhered to the Armenian hypertension guidelines. Although 92% of PCPs indicated that their clinic has a registry of patients with hypertension, only 30% had confidence in using one. PCPs who participated in the U.S. Agency for International Development (USAID) training program had 1.89 times higher cumulative odds of spending more time with each patient (95% CI: 1.22-2.93, p = 0.004). Those who completed an internal medicine (IM) residency had 2.04 times higher cumulative odds of spending more time with each patient compared to those trained in family medicine (FM) (95% CI: 1.26-3.32, p = 0.004). PCPs who completed IM residencies had lower practice and priority scores than those in FM. PCPs near the capital had 88% lower odds of referring patients early to specialists compared to those in non-contiguous provinces (OR = 0.12, 95% CI: [0.07, 0.21], p < 0.001). CONCLUSIONS: PCPs in Armenia prioritize hypertension and report desirable practices, but gaps in their knowledge, lifestyle counseling, and confidence in registry use remain. These findings underscore the need for additional training, policies to reduce barriers, and further studies to elucidate the reasons behind the "know-do" gap.