HYPERTENSION MANAGEMENT AND PRESCRIBING PRACTICES IN PRIMARY HEALTHCARE SETTINGS IN QATAR: A MULTI-METHODS

Abstract

Background: The use of antihypertensive medications controls blood pressure (BP) and reduces the incidence of complications. This study explored the prescribing patterns and trends of antihypertensive medications utilization, as well as perceived barriers, facilitators, and strategies for managing hypertension from physicians' perspective in primary healthcare centers in Qatar. The study also assessed BP control among hypertensive patients. Methods: The first phase is a retrospective chart review. The second phase is a mixed-method explanatory sequential design study. Results: Between 2018 and 2021, the most prescribed antihypertensives were calcium channel blockers (CCBs) (22.9%, 26.5%, 32.5%, and 33.0% respectively). Angiotensin converting enzyme inhibitors prescribing decreased from 27.0% in 2017 to 18.0% in 2021 and thiazide diuretics prescribing decreased from 19.0% in 2017 to 8.0%. While CCBs prescribing increased from 21.0% in 2017 to 33.0% in 2021, and angiotensin receptor blockers prescribing increased from 20.0% in 2017 to 26.0% in 2021. Majority of patients had controlled blood pressure ranging from 56.9% to 81.9% across the years from 2018 to 2020. Patients with dyslipidemia, heart failure, and Qatari citizens were more likely to have controlled BP (adjusted OR=1.448, 2.417, 1.481 respectively). In phase 2, seven components loaded: physicians' knowledge and skills, confidence in their role and identity, ability to remember to prescribe antihypertensives as per the guidelines, beliefs about consequences, goals, and intentions, perceived environmental context resources, and perceived social influences. Fourteen themes emerged. Examples include physicians' sources of knowledge about hypertension management, role in hypertension management, confidence about prescribing decisions, optimism regarding antihypertensives prescriptions yielding positive outcomes, goals when managing hypertension, methods to ensure their prescribing of antihypertensives is appropriate, emotions and experiences when prescribing antihypertensives, barriers and facilitators when prescribing antihypertensives and strategies to improve hypertension management in Qatar. Conclusions: Several barriers, facilitators and strategies were discussed to improve antihypertensive prescribing. Overall, prescribing patterns of antihypertensives were found to be similar to what is published in the literature. Majority of physicians reported following hypertension management guidelines. Further studies are needed to fully assess antihypertensives prescribing appropriateness.