Fahey T, Silagy C
Department of Public Health Medicine, Kettering Health Authority, Oxford.
Br J Gen Pract. 1994 Oct;44(387):446-9.
It is not known whether the results from randomized controlled trials influence general practitioners' knowledge of and attitudes to clinical practice.
This study set out to assess general practitioners' knowledge of and attitudes to the management of hypertension in patients aged 65 years and over after the publication of three randomized controlled trials.
A cross-sectional survey of principals in general practice was undertaken using a self-administrated questionnaire. The study was confined to 35 randomly selected general practices whose patient catchment area lay within the boundary of Northamptonshire Family Health Services Authority. A total of 92 general practitioners from 27 practices responded. The main outcome measures were: the reported use of a protocol to manage elderly patients with hypertension; method and frequency of blood pressure measurement; influence of patients' age on diagnosing and initiating treatment of hypertension; and use of non-pharmacological and pharmacological therapies.
Eighty four per cent of the general practitioners reported starting treatment only after measuring blood pressure on three separate occasions; 99% measured blood pressure with the patient seated while 29% also measured blood pressure while the patient was standing. Half of the respondents reported treating patients with isolated systolic hypertension once systolic blood pressure exceeded 179 mmHg. All the general practitioners reported recommending non-pharmacological treatment prior to drug therapy; 83% would use a diuretic as their drug of first choice.
It appears that despite the publication of several sets of guidelines for the management of hypertension in elderly people, based on randomized controlled trials, there is still considerable variation in the knowledge and attitudes of general practitioners. However, compared with a previous survey in Leicestershire in 1991, the general practitioners in this study reported a lower blood pressure threshold for initiating treatment of elevated blood pressure in elderly patients, including those with isolated systolic hypertension, which may in part be attributed to the introduction of the guidelines.
尚不清楚随机对照试验的结果是否会影响全科医生对临床实践的认知和态度。
本研究旨在评估三项随机对照试验发表后，全科医生对65岁及以上高血压患者治疗的认知和态度。
采用自填式问卷对全科医疗负责人进行横断面调查。该研究限于随机选取的35家全科医疗诊所，其患者覆盖区域位于北安普敦郡家庭健康服务管理局辖区内。来自27家诊所的92名全科医生进行了回复。主要观察指标为：报告使用的老年高血压患者治疗方案；血压测量方法及频率；患者年龄对高血压诊断和治疗起始的影响；非药物和药物治疗的使用情况。
84%的全科医生报告仅在三次不同时间测量血压后才开始治疗；99%在患者坐位时测量血压，29%还在患者站立时测量血压。一半的受访者报告，一旦收缩压超过179 mmHg，就会治疗单纯收缩期高血压患者。所有全科医生均报告在药物治疗前推荐非药物治疗；83%会将利尿剂作为首选药物。
尽管基于随机对照试验发表了几套老年人高血压治疗指南，但全科医生的认知和态度仍存在相当大的差异。然而，与1991年在莱斯特郡进行的一项先前调查相比，本研究中的全科医生报告，在老年患者（包括单纯收缩期高血压患者）中启动高血压治疗的血压阈值较低，这可能部分归因于指南的引入。
