Competence of Polish primary-care doctors in the pharmacological treatment of hypertension


Dr Adam Windak
Department of Internal Medicine and Gerontology
Jagiellonian University Medical College
ul. Bocheńska 4
31-061 Kraków


Rationale, aims and objectives  Compliance with treatment guidelines for hypertension is variable. This study assessed the competence of Polish general practitioners in compliance with hypertension treatment guidelines, and doctor and patient characteristics associated with compliance.

Methods  The study was conducted on a random sample of Polish primary-care doctors working in clinics contracted by the national health insurance funds. Doctors completed a questionnaire consisting of eight case vignettes describing patients with elevated blood pressure. The cases differed on three variables relating to the level of blood pressure, the presence or absence of diabetes mellitus, and the presence or absence of other risk factors. Doctors were asked to give their treatment decision for each case. Demographic data and details of the doctor's practice were also collected. Treatment decisions were tabulated, and associations between doctor and patient characteristics and treatments were assessed.

Results  One hundred twenty-five doctors (65% response rate) completed the questionnaire. Compliance with treatment guidelines was judged to be 51%. Poor compliance with guidelines was noted for patients with diabetes mellitus. The level of blood pressure was the strongest predictor of drug treatment. Angiotensin-converting enzyme inhibitors were the most frequently prescribed medications. Appropriate decisions were associated with practice in large cities.

Conclusions  Compliance with hypertension treatment guidelines was judged to be poor in this study of a sample of Polish primary-care doctors using case vignettes to test competence. Additional emphasis on hypertension guidelines in training doctors is needed, especially for diabetic patients and for doctors outside urban centres.