Open Access Highly Accessed Research article

Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study

Raija Sipilä1*, Arja Helin-Salmivaara23, Maarit Jaana Korhonen45 and Eeva Ketola6

Author Affiliations

1 Current Care, Finnish Medical Society Duodecim, POB 713, 00100 Helsinki, Finland

2 Department of Pharmacology, Drug Development and Therapeutics, University of Turku, 20014 Turku, Finland

3 Unit of General Practice, Hospital District of Helsinki and Uusimaa, POB 705, FI-00029 Helsinki, Finland

4 Department of Pharmacology, Drug Development and Therapeutics, University of Turku, FI-20014 Turku, Finland

5 Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland

6 Helsinki City Health Department, POB 6000, FI-00099 City of Helsinki, Finland

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BMC Family Practice 2011, 12:87  doi:10.1186/1471-2296-12-87

Published: 17 August 2011



Antihypertensive drug choices and treatment levels are not in accordance with the existing guidelines. We aimed to assess the impact of a guideline implementation intervention on antihypertensive drug prescribing.


In this controlled before and after study, the effects of a multifaceted (education, audit and feedback, local care pathway) quality programme was evaluated. The intervention was carried out in a health centre between 2002 and 2003. From each health care unit (n = 31), a doctor-nurse pair was trained to act as peer facilitators in the intervention.

All antihypertensive drugs prescribed by 25 facilitator general practitioners (intervention GPs) and 53 control GPs were retrieved from the nationwide Prescription Register for three-month periods in 2001 and 2003. The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes.


In all subgroups, the use of multiple concurrent medications increased. For intervention patients with hypertension only, the odds ratio (OR) was 1.12 (95% CI 0.99, 1.25; p = 0.06) and for controls 1.13 (1.05, 1.21; p = 0.002). We observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups. The use of agents acting on the renin-angiotensin-aldosterone system increased in all subgroups (hypertension only intervention patients OR 1.19 (1.06, 1.34; p = 0.004) and controls OR 1.24 (1.15, 1.34; p < 0.0001).


A multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.