ArticleBMC family practice2005
Perceived barriers for treatment of chronic heart failure in general practice; are they affecting performance?
Article in BMC family practice, 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Improvement of primary care for patients with chronic heart failure: a study protocol for a cluster randomised trial comparing two strategies.Implementation science : IS · 2011Trial
- A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients.BMC health services research · 2022Article
- Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis.BMJ open · 2016Article
- Chronic Heart Failure Clinical Practice Guidelines' Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy?ASEAN heart journal : Official journal of the ASEAN Federation of Cardiology · 2016Article
- Design and methodology of the COACH-2 (Comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2012Article
- Influence of patient age and comorbid burden on clinician attitudes toward heart failure guidelines.The American journal of geriatric pharmacotherapy · 2012Article
- Physician and patient predictors of evidence-based prescribing in heart failure: a multilevel study.PloS one · 2012Article
- A taxonomy of reasons for not prescribing guideline-recommended medications for patients with heart failure.The American journal of geriatric pharmacotherapy · 2010Article
- Developing and selecting interventions for translating knowledge to action.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2010Review
- Improvement of primary care for patients with chronic heart failure: a pilot study.BMC health services research · 2010Article
- Self-reported and actual beta-blocker prescribing for heart failure patients: physician predictors.PloS one · 2009Article
- Managing evidence-based knowledge: the need for reliable, relevant and readable resources.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2009Article
- Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study.European journal of clinical pharmacology · 2005Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe aim of this study is to determine to what extent barriers perceived by general practitioners (GPs) for prescribing angiotensin-converting enzyme inhibitors (ACE-I) in chronic heart failure (CHF) patients are related to underuse and underdosing of these drugs in actual practice.
methodsBarriers were assessed with a semi-structured questionnaire. Prescribing data were extracted from GPs' computerised medical records for a random sample of their CHF patients. Relations between barriers and prescribing behaviour were assessed by means of Spearman rank correlation and multivariate regression modelling.
resultsGPs prescribed ACE-I to 45% of their patients and had previously initiated such treatment in an additional 3.5%, in an average standardised dose of 13.5 mg. They perceived a median of four barriers in prescribing ACE-I or optimising ACE-I dose. Many GPs found it difficult to change treatment initiated by a cardiologist. Furthermore, initiating ACE-I in patients already using a diuretic or stable on their current medication was perceived as barrier. Titrating the ACE-I dose was seen as difficult by more than half of the GPs. No significant relationships could be found between the barriers perceived and actual ACE-I prescribing. Regarding ACE-I dosing, the few GPs who did not agree that the ACE-I should be as high as possible prescribed higher ACE-I doses.
conclusionVariation between GPs in prescribing ACE-I for CHF cannot be explained by differences in the barriers they perceive. Tailor-made interventions targeting only those doctors that perceive a specific barrier will therefore not be an efficient approach to improve quality of care.
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