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Michel Burnier, MD, comments on a new system developed by Yuan Lu, ScD, and colleagues to improve clinician adherence to severe BP guidelines.

Guidelines for severe hypertension management exist, yet clinicians tend not to adhere to them. A new classification system identifies causes for this gap and suggests approaches to improve adherence, according to findings published in JAMA Network Open.

The researchers developed a taxonomy of scenarios involved in treatment non-initiation or non-intensification. This taxonomy includes:

• Clinician-related scenarios related to intention, capability, or scope, including not addressing treatment initiation or intensification OR diffusion of responsibility;
• Patient-related scenarios due to patient behavioral considerations, including patient nonadherence and patient preference;
• Scenarios related to clinical complexity, including diagnostic uncertainty or maintenance of current intervention; and
• Competing medical priorities.

Accompanying Editorial

In an accompanying editorial, Michel Burnier, MD, agreed that a healthcare team approach benefits providers and patients. The commentary was also published in JAMA Network Open.

“In addition to the increased workload, physicians are confronted with an increasing number of patients requiring more time to discuss other comorbidities and risk factors, in addition to adherence issues,” he wrote. This constraint clearly promotes medical inertia but could be overcome by involving all members of the care team (eg, nurses, pharmacists, and dietitians) in the management of hypertension,” Dr. Burnier wrote. “Today, team-based care and patient empowerment are strongly recommended as cost-effective ways to improve hypertension management.”

Read our PW Q&A with Yuan Lu, ScD, study author of “Barriers to optimal clinician guideline adherence in management of markedly elevated blood pressure: a qualitative study” here!