Primary care guidelines: Senior executives' views on changing health centre practices in hypertension treatment

Objective. To describe the adoption of the national Hypertension Guideline in primary care and to evaluate the consistency of the views of the health centre senior executives on the guideline's impact on clinical practices in the treatment of hypertension in their health centres. Design. A cross-sectional telephone survey. Setting. All municipal health centres in Finland. Subjects. Health centres where both the head physician and the senior nursing officer responded. Main outcome measures. Agreement in views of the senior executives on the adoption of clinical practices as recommended in the Hypertension Guideline. Results. Data were available from 143 health centres in Finland (49%). The views of head physicians and senior nursing officers on the adoption of the Hypertension Guideline were not consistent. Head physicians more often than senior nursing officers (44% vs. 29%, p < 0.001) reported that no agreements on recording target blood pressure in patient records existed. A similar discrepancy was seen in recording cardiovascular risk (64% vs. 44%, p < 0.001). Senior executives agreed best on the calibration of sphygmomanometers and the provision of weight-control group counselling. Conclusions. Hypertension Guideline recommendations that require joint agreements between professionals are less often adopted than simple, precise recommendations. More emphasis on effective multidisciplinary collaboration is needed.