1. Managing hypertension in frail oldest-old—The role of guideline use by general practitioners from 29 countries
- Author
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Roulet, C., Rozsnyai, Z., Jungo, K.T., Ploeg, M.A. van der, Floriani, C., Kurpas, D., Vinker, S., Pestic, S.K., Petrazzuoli, F., Hoffmann, K., Viegas, R.P.A., Mallen, C., Tatsioni, A., Maisonneuve, H., Collins, C., Lingner, H., Tsopra, R., Mueller, Y., Poortvliet, R.K.E., Gussekloo, J., Streit, S., University of Bern, Leiden University Medical Center (LUMC), Wrocław Medical University, Tel Aviv University [Tel Aviv], University of Tuzla, Lund University [Lund], Medizinische Universität Wien = Medical University of Vienna, NOVA Medical School - Faculdade de Ciências Médicas (NMS), Universidade Nova de Lisboa = NOVA University Lisbon (NOVA), Keele University [Keele], University of Ioannina, Université de Genève = University of Geneva (UNIGE), Irish College of General Practitioners [Dublin, Irlande] (ICGP), Hannover Medical School [Hannover] (MHH), Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lausanne = University of Lausanne (UNIL), Leiden University, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Bodescot, Myriam, University of Wrocław [Poland] (UWr), Tel Aviv University (TAU), Univerzitet u Tuzli [Tuzla, Bosnie-Herzégovine], Centre de Recherche des Cordeliers (CRC (UMR_S_1138 / U1138)), École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Prof. Streit’s research was supported by grants (P2BEP3_165353) from the Swiss National Science Foundation (SNF) and the Gottfried and Julia Bangerter-Rhyner Foundation, Switzerland. Christian Mallen is funded by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR SPCR and a NIHR Research Professorship in General Practice, (NIHR-RP-2014-04-026)., University of Geneva [Switzerland], Sciences de l’information au service de la médecine personnalisée = Information Sciences to support Personalized Medicine [CRC], Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université de Paris (UP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Université de Lausanne (UNIL), and Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Université Paris Cité (UPCité)-École pratique des hautes études (EPHE)
- Subjects
Medical Doctors ,Health Care Providers ,[SDV]Life Sciences [q-bio] ,Blood Pressure ,Cardiovascular Medicine ,Vascular Medicine ,MESH: Hypertension ,Geographical Locations ,MESH: Aged, 80 and over ,MESH: Practice Guidelines as Topic ,RA0421 ,Medicine and Health Sciences ,Medical Personnel ,Aged, 80 and over ,MESH: Aged ,Frailty ,[SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,Agricultural and Biological Sciences(all) ,[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology ,MESH: Clinical Decision-Making ,Drugs ,MESH: Blood Pressure ,3. Good health ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,MESH: General Practitioners ,Europe ,Professions ,Cardiovascular Diseases ,Hypertension ,Practice Guidelines as Topic ,Medicine ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Research Article ,Frail Elderly ,Science ,Clinical Decision-Making ,education ,610 Medicine & health ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,SDG 3 - Good Health and Well-being ,General Practitioners ,360 Social problems & social services ,Physicians ,Humans ,General ,Aged ,Pharmacology ,[SDV.IB] Life Sciences [q-bio]/Bioengineering ,Treatment Guidelines ,Health Care Policy ,MESH: Humans ,Biochemistry, Genetics and Molecular Biology(all) ,MESH: Frail Elderly ,R1 ,Health Care ,Geriatrics ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,People and Places ,Population Groupings ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,RA ,Antihypertensives - Abstract
BackgroundThe 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/settingCross-sectional study among currently active GPs from 29 countries using a case-vignettes survey.MethodsGPs 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.ResultsOverall, 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 (pConclusionMany 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.
- Published
- 2020
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