Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

Background: Clinical guidelines are systematically developed statements that assist practitioners and patients to make healthcare decisions for specific clinical circumstances. Non-adherence of doctors to guidelines is thought to contribute significantly to poor delivery of clinical care, resulting in poor clinical outcomes. Aim: To investigate adherence of doctors in rural district hospitals to clinical guidelines using the South African Hypertension Guideline 2006 as an example. Setting: Four district hospitals in Bojanala district of North-West Province, South Africa. Methods: A cross-sectional study determined adherence practices of doctors from records of patients with established hypertension seen at the four district hospitals. Results: Of the 490 total records documented by 29 doctors, screening for co-morbidity or associated factors was carried out as follows: diabetes mellitus 99.2%, obesity 6.1%, smoking 53.5%, dyslipidaemia 36.9%, abdominal circumference 3.3%; organ damage: eye 0, kidney 82%, heart 43.5%, chronic kidney disease 38.2%, stroke/transient ischaemic attack 15.9%, heart failure 23.5%, advanced retinopathy 0.2%, coronary heart disease 23.7%, peripheral arterial disease 13.9%. Critical tests/measurements were documented in the following proportions: blood pressure 99.8%, weight 85.3%, height 65.7%, body mass index 3.1%, urinalysis 74.5%, lipogram 76.1%, urea/creatinine 80.4%, electrocardiogram 42.9%, blood glucose 100%; risk determination and grading: diagnosis by hypertension severity 19%, low added risk 57.1%, moderate added risk 64.7%, high added risk 89.6%, very high added risk 89.2%. Adherence to therapies was as follows: first-line guideline drugs 69.4%, second line 84.7%, third line 87.8% and fourth-line 89.6%. Conclusion: Overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). Low adherence rates were related to age (older doctors) and less clinical experience, and differed with regard to various aspects of the guidelines.