Prescribers' adherence to clinical practice guidelines for the management of hypertension at public hospitals in Northwest Ethiopia: An explanatory sequential mixed-methods study.

Abstract

Hypertension (HTN) is a leading lifestyle disease and a major cause of morbidity and mortality worldwide, especially in sub-Saharan Africa. Clinical practice guidelines (CPGs) serve as useful tools for clinical decision-making by leading clinicians to measure appropriateness and ultimately measure the quality of care and reduce clinical inertia. This study aimed to assess prescribers' awareness, adherence to CPGs, barriers to it, and its associated factors among prescribers working at public hospitals in Northwest Ethiopia. A multicenter explanatory sequential mixed-methods study was conducted between October 01, 2023 and January 30, 2024. STATA version 17.0 was used for analysis, following entry of data into EpiData (version 4.6.0.0). Adherence of prescribers to HTN CPGs was determined using the scoring system results of the JNC 7 adherence scale. Associations between variables were assessed by the Chi-square (&#x3c7;²) test. An adjusted odds ratio (AOR) with 95% CI with a <i>p</i>-value &lt;0.05 was considered statistically significant in multivariable logistic regression analysis. In the present study, out of 403 prescribers approached, 370 completed the interview, resulting in a response rate of 91.8%. Most of the prescribers (90.5%) were aware of HTN CPGs. More than one-third (41.1%) of the prescribers were low adherent to the HTN CPGs. Prescribers with 1-5&#x2009;years (AOR&#x2009;=&#x2009;3.22, 95% CI&#x2009;=&#x2009;1.27-8.15) and 6-10&#x2009;years (AOR&#x2009;=&#x2009;4.59, 95% CI&#x2009;=&#x2009;1.62-11.05) of experience; the availability of resource in the hospital (AOR&#x2009;=&#x2009;1.78, 95% CI&#x2009;=&#x2009;1.11-2.87), and qualification, with general practitioners (AOR&#x2009;=&#x2009;2.98, 95% CI&#x2009;=&#x2009;1.46-6.10) and nurses (BSc and above) (AOR&#x2009;=&#x2009;7.29, 95% CI&#x2009;=&#x2009;3.55-10.91) were significantly associated with high adherence to CPGs. The qualitative part of the study identified barriers to HTN CPGs, including limited resources, patient influence, and complexity of the guidelines. Participants recommended improving access, updating and simplifying CPGs, and enhancing institutional support. More than one-third of the prescribers were low adherent to CPGs. Continuous training and education in terms of using evidence-based therapeutic guidelines is crucial in patient care and reduces clinical inertia. To promote excellence in clinical practice, concerted efforts are needed to promote application of evidence-based HTN treatment guidelines. Current clinical practice guidelines and hypertension management practices High blood pressure (hypertension) is a major public health issue, especially in Sub-Saharan Africa. Following clinical practice guidelines is important to improve patient care. This study assessed at how prescribers in public comprehensive specialized hospitals in Northwest Ethiopia are following clinical practice guidelines during management of high blood pressure. Out of 370 prescribers, most knew about the clinical guidelines, but over half were not fully following them. Factors like work experience, qualification, and resources availability were associated with adherence to clinical practice guidelines. Interviews with some prescribers also revealed challenges like lack of access to medicines, patient pressure, and complex guidelines. They suggested better access, regular training, and simpler clinical guidelines to help improve patient care. Overall, more support is needed to help prescribers use clinical practice guidelines consistently in treating high blood pressure.