[논문]진료를 받는 고혈압 환자의 혈압 조절과 관련된 의사 요인

김소영; 조인숙; 이재호; 김지현; 이은정; 박종혁; 이진석; 김윤

doi:10.3961/jpmph.2007.40.6.487

진료를 받는 고혈압 환자의 혈압 조절과 관련된 의사 요인
Physician Factors Associated with the Blood Pressure Control among Hypertensive Patients 원문보기

Journal of preventive medicine and public health = 예방의학회지, v.40 no.6, 2007년, pp.487 - 494

김소영 (서울대학교 의과대학 의료관리학교실) , 조인숙 (인하대학교 의과대학 간호학과) , 이재호 (서울아산병원 응급의학과) , 김지현 (EHR 핵심공통기술연구개발사업) , 이은정 (서울대학교 의과대학 의료관리학교실) , 박종혁 (국립암센터) , 이진석 (서울대학교 의과대학 의료관리학교실) , 김윤 (서울대학교 의과대학 의료관리학교실)

Abstract ▼ AI-Helper

Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.

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참고문헌 (37)

Joint National Committee: The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157(21): 2413-2446

상세보기
Ministry of Health and Welfare. The Third Korea National Health and Nutrition Examination Survey, 2005. Ministry of Health and Welfare; 2006 (Korean)
Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: Results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2000; 356(9246): 1955-1964

상세보기
Turnbull F, Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 2003; 362(9395): 1527-1535

상세보기
Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH. Health outcomes associated with various antihypertensive therapies used as first-line agents: A network meta-analysis. JAMA 2003; 289(19): 2534-2544

상세보기
Kim SG, Kim SA, Park WS. Prevalence and management status of hypertension in Korea. Korean Hypertens J 2006; 12(2): 7-15 (Korean)
Choi YH, Nam CM, Joo MH, Moon KT, Shim JS, Kim HC, Suh I. Awareness, treatment, control, and related factors of hypertension in Gwacheon. Korean J Prev Med 2003; 36(3): 263-270 (Korean)
Ha YC, Chun HJ, Hwang HK, Kim BS, Kim JP. The prevalence, awareness, treatment, and control of hypertension and related factors in rural Korea. Korean J Prev Med 2000; 33(4): 513-520 (Korean)
Kim CY, Lee KS, Khang YH, Lim J, Choi YJ, Lee KH, Kim YI. Health behaviors related to hypertension in rural population of Korea. Korean J Prev Med 2000; 33(1): 56-68 (Korean)
Borzecki AM, Oliveria SA, Berlowitz DR. Barriers to hypertension control. Am Heart J 2005; 149(5): 785-794

상세보기
Dusing R. Overcoming barriers to effective blood pressure control in patients with hypertension. Curr Med Res Opin 2006; 22(8): 1545-1553

상세보기
Pittrow D, Kirch W, Bramlage P, Lehnert H, Hofler M, Unger T, Sharma AM, Wittchen HU. Patterns of antihypertensive drug utilization in primary care. Eur J Clin Pharmacol 2004; 60(2): 135-142

상세보기
Oliveria SA, Lapuerta P, McCarthy BD. Physician-related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002; 162(4): 413-420

상세보기
Steinman MA, Fischer MA, Shlipak MG, Shlipak MG, Bosworth HB, Oddone EZ, Hoffman BB, Goldstein MK. Clinician awareness of adherence to hypertension guidelines. Am J Med 2004; 117(10): 747-754

상세보기
Phillips LS, Branch WT, Cook CB, Doyle JP, El-Kebbi IM, Gallina DL, Miller CD, Ziemer DC, Bames CS. Clinical inertia. Ann Intern Med 2001; 135(9): 825-834

상세보기
Faulhaber HD, Luft FC. Treatment of high blood pressure in Germany. Am J Hypertens 1998; 11(6 Pt 1): 750-753

상세보기
Chockalingam A, Fodor JG. Treatment of raised blood pressure in the population: The Canadian experience. Am J Hypertens 1998; 11(6Pt 1): 747-749

상세보기
Banegas JR, Rodriguez-Artalejo F, de la Cruz Troca JJ, Gua1lar-Castillon P, del Rey Calero J. Blood pressure in Spain: Distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension 1998; 32(6): 998-1002

상세보기
Berlowitz DR, Ash AS, Hickey EC, Friedman RH, Glickman M, Kader B, Moskowitz MA. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339(27): 1957-1963

상세보기
O'Connor PJ. Overcome clinical inertia to control systolic blood pressure. Arch Intern Med 2003; 163(22): 2677-2678

상세보기
Asai Y, Heller R, Kajii E. Hypertension control and medication increase in primary care. J Hum Hypertens 2002; 16(5): 310-318
Hyman DJ, Pavlik VN. Self-reported hypertension treatment practices among primary care physicians: Blood pressure thresholds, drug choices, and the role of guidelines and evidence-based medicine. Arch Intern Med 2000; 160(15): 2281-2286

상세보기
Bosworth HB, Olsen MK, Oddone EZ. Improving blood pressure control by tailored feedback to patients and clinicians. Am Heart J 2005; 149(5): 795-803

상세보기
Ministry of Health and Welfare. Guidelines of chronic disease management project 2006. Ministry of Health and Welfare; 2006 (Korean)
Bae SS, Kim J, Min KB, Kwon SH, Han DS. Patient compliance and associated factors in the community based hypertension control program. Korean J Prev Med 1999; 32(2): 215-227 (Korean)
Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345(7): 479-486

상세보기
Korean Society of Hypertension. 2004 Korean Hypertension Treatment Guidelines. Korean Society of Hypertension; 2004
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, and the National high Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA. 2003; 289(19): 2560-2592

상세보기
Ehrlinger J, Dunning D. How chronic self-views influence (and potentially mislead) estimates of performance. J Pers Soc Psychol 1999; 77(1): 5-17

상세보기
Saturno PJ, Palmer RH, Gascon JJ. Physician attitudes, self-estimated performance and actual compliance with locally peer-defmed quality evaluation criteria. Int J Qual Health Care 1999; 11(6): 487-496

상세보기
Weingarten S, Stone E, Hayward R, Tunis S, Pelter M, Huang H, Kristopaitis R. The adoption of preventive care practice guidelines by primary care physicians: Do actions match intentions? J Gen Intern Med 1995; 10(3): 138-144

상세보기
Leaf DA, Neighbor WE, Schaad D, Scott CS. A comparison of self-report and chart audit in studying resident physician assessment of cardiac risk factors. J Gen Intern Med 1995; 10(4): 194-198

상세보기
Greco PJ, Eisenberg JM. Changing physicians' practices. N Engl J Med 1993; 329(17): 1271-1273

상세보기
Wagner EH, Austin BT, Yon Korff M. Organizing care for patients with chronic illness. Milbank Q 1996; 74(4): 511-544

상세보기
Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome: A critical appraisal of research. Annals Int Med 1994; 120(2): 135-142

상세보기
Persson M, Mjorndal T, Carlberg B, Bohlin J, Lindholm LH. Evaluation of a computer-based decision support system for treatment of hypertension with drugs: Retrospective, nonintervention testing of cost and guideline adherence. J Int Med 2000; 247(1): 87-93

상세보기
Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension. J Gen Intern Med 1997; 12(11): 672-678

상세보기

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