Original Research

Adherence of doctors to a clinical guideline for hypertension in Bojanala district, North-West Province, South Africa

Asafa R. Adedeji, John Tumbo, Indiran Govender
African Journal of Primary Health Care & Family Medicine | Vol 7, No 1 | a776 | DOI: https://doi.org/10.4102/phcfm.v7i1.776 | © 2015 Asafa R. Adedeji, John Tumbo, Indiran Govender | This work is licensed under CC Attribution 4.0
Submitted: 29 September 2014 | Published: 13 April 2015

About the author(s)

Asafa R. Adedeji, Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, South Africa
John Tumbo, Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, South Africa
Indiran Govender, Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, South Africa


Background: Clinical guidelines are systematically developed statements that assist practitioners and patients to make healthcare decisions for specific clinical circumstances. Non-adherence of doctors to guidelines is thought to contribute significantly to poor delivery of clinical care, resulting in poor clinical outcomes.

Aim: To investigate adherence of doctors in rural district hospitals to clinical guidelines using the South African Hypertension Guideline 2006 as an example.

Setting: Four district hospitals in Bojanala district of North-West Province, South Africa.Methods:A cross-sectional study determined adherence practices of doctors from records of patients with established hypertension seen at the four district hospitals.

Results: Of the 490 total records documented by 29 doctors, screening for co-morbidity or associated factors was carried out as follows: diabetes mellitus 99.2%, obesity 6.1%, smoking 53.5%, dyslipidaemia 36.9%, abdominal circumference 3.3%; organ damage: eye 0, kidney 82%, heart 43.5%, chronic kidney disease 38.2%, stroke/transient ischaemic attack 15.9%, heart failure 23.5%, advanced retinopathy 0.2%, coronary heart disease 23.7%, peripheral arterial disease 13.9%. Critical tests/measurements were documented in the following proportions: blood pressure 99.8%, weight 85.3%, height 65.7%, body mass index 3.1%, urinalysis 74.5%, lipogram 76.1%, urea/creatinine 80.4%, electrocardiogram 42.9%, blood glucose 100%; risk determination and grading: diagnosis by hypertension severity 19%, low added risk 57.1%, moderate added risk 64.7%, high added risk 89.6%, very high added risk 89.2%. Adherence to therapies was as follows: first-line guideline drugs 69.4%, second line 84.7%, third line 87.8% and fourth-line 89.6%.

Conclusion: Overall adherence of doctors to treatment guidelines for hypertension was found to be low (51.9%). Low adherence rates were related to age (older doctors) and less clinical experience, and differed with regard to various aspects of the guidelines.


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Crossref Citations

1. The adoption of hypertension reference framework: An investigation among primary care physicians of Hong Kong
Yuan Fang, Harry H. X. Wang, Miaoyin Liang, Ming Sze Yeung, Colette Leung, Chun Hei Chan, Wilson Cheung, Jason L. W. Huang, Junjie Huang, Regina W. S. Sit, Samuel Y. S. Wong, Martin C. S. Wong, Lars-Peter Kamolz
PLOS ONE  vol: 13  issue: 10  first page: e0205529  year: 2018  
doi: 10.1371/journal.pone.0205529