Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings

Abstract

Aim      To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods  This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life – BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39–4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18–4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51–160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08–3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69–9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01–1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65–6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31–2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05–0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64–0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06–0.36; p<0.001).Conclusion      The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working conditions, and emotional exhaustion (a component of professional burnout), older age of patients and their excessive alcohol consumption.