Managing hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. DESIGN/SETTING: Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. METHODS: GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries. RESULTS: Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used. CONCLUSION: Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.

Details

Authors
  • Céline Roulet
  • Zsofia Rozsnyai
  • Katharina Tabea Jungo
  • Milly A van der Ploeg
  • Carmen Floriani
  • Donata Kurpas
  • Shlomo Vinker
  • Sanda Kreitmayer Pestic
  • Kathryn Hoffmann
  • Rita P.A. Viegas
  • Christian Mallen
  • Athina Tatsioni
  • Hubert Maisonneuve
  • Claire Collins
  • Heidrun Lingner
  • Rosy Tsopra
  • Yolanda Mueller
  • Rosalinde K.E. Poortvliet
  • Jacobijn Gussekloo
  • Sven Streit
Organisations
External organisations
  • University of Bern
  • Leiden University Medical Centre
  • Wrocław Medical University
  • Tel-Aviv University
  • University of Tuzla
  • Medical University of Vienna
  • New University of Lisbon
  • Keele University
  • University of Ioannina
  • University of Geneva
  • Hannover Medical School
  • Institut Gustave Roussy
  • University of Lausanne
  • Leiden University
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Health Care Service and Management, Health Policy and Services and Health Economy
  • Gerontology, specializing in Medical and Health Sciences
Original languageEnglish
Article numbere0236064
JournalPLoS ONE
Volume15
Issue number7
Publication statusPublished - 2020 Jan 1
Publication categoryResearch
Peer-reviewedYes