A Synthesized Model of Compliance Based on Physician and Patient Reported Barriers to Hypertension Guidelines

Hypertension affects as many as 50-70 million Americans; early and consistent compliance to hypertension guidelines is important to prevent heart attack and stroke, both leading causes of death in the United States. Despite the advances in medicine and health-care technology, the effectiveness with which hypertension is managed at the individual and community level is less than optimal. The research questions in this study addressed the lack of physician compliance to hypertension guidelines and why patients fail to follow guidelines. Improving hypertension management depends on bridging the gap between physician awareness of evidence-based guidelines and patient compliance. Grounded theory was used to understand and integrate the perspectives of a purposeful selection of nine physicians and seven patients regarding barriers to hypertension guidelines compliance. Theoretical perspectives used to frame this research were self-efficacy and the health-belief model for the patient and awareness to adherence and the dissemination model for the physician. Data analysis strategies included open/axial and in-vivo coding to assign and refine themes and discover key concepts. Themes for both physician and patient participants related to methods of compliance, the physician/patient relationship, awareness of theoretical models by both groups, and issues related to patient non-compliance. Eight key recommendations were developed, including: evidence and theory must coexist to increase compliance, health insurance practices must be reformed, and collaboration and communication between physicians and patients must improve. Implications for positive social change included reduced health care costs and improved outcomes for hypertensive patients