Research Article: The adoption of hypertension reference framework: An investigation among primary care physicians of Hong Kong

Date Published: October 9, 2018

Publisher: Public Library of Science

Author(s): Yuan Fang, Harry H. X. Wang, Miaoyin Liang, Ming Sze Yeung, Colette Leung, Chun Hei Chan, Wilson Cheung, Jason L. W. Huang, Junjie Huang, Regina W. S. Sit, Samuel Y. S. Wong, Martin C. S. Wong, Lars-Peter Kamolz.


The Hong Kong Government released a Reference Framework (RF-HT) for Hypertension Care for Adults in Primary Care Settings since 2010. No studies have evaluated its adoption by primary care physicians (PCPs) since its release.

We aimed to evaluate the level of PCPs’ adoption of the RF-HT and the potential barriers of its use in family practice.

A cross-sectional study was conducted by a self-administered validated survey among all PCPs in Hong Kong through various means.

We assessed the level of and factors associated with its adoption by multivariate logistic regression modelling.

A total of 3,857 invitation episodes were sent to 2,297 PCPs in 2014–2015. We received 383 completed questionnaires. The average score of adoption was 3.43 out of 4.00, and 47.5% of PCPs highly adopted RF-HT in their daily consultations. Male practitioners (adjusted odds ratio [aOR] = 0.524, 95% CI = 0.290–0.948, p = 0.033) and PCPs of public sector (aOR = 0.524, 95% CI = 0.292–0.940, p = 0.030) were significantly less likely to adopt the RF-HT. PCPs with higher training completion or being academic fellow are more likely to adopt RF-HT than those who were “nil to basic training completion” (aOR = 0.479, 95% CI = 0.269–0.853, p = 0.012) or “higher trainee” (aOR = 0.302, 95% CI = 0.093–0.979, p = 0.046). Three most-supported suggestions on RF-HT improvement were simplification of RF-HT, provision of pocket version and promoting in patients.

Among PCP respondents, the adoption level of the RF-HT was high. These findings also highlighted some factors associated with its adoption that could inform targeted interventions for enhancing its use in clinical practice.

Partial Text

Worldwide, hypertension accounts for 7.6 million premature deaths and 92 million disability-adjusted life years (DALY) annually, and contributes to 47% of ischemic heart disease and 54% of stroke [1]. Although its prevalence is growing [2, 3], its control rate remains low in many countries [3–6]. In Hong Kong, the proportion of people diagnosed with hypertension increased from 9.3% in 2008, to 10.3% in 2009/10, and 11.0% in 2011/12 [7]. However, according to a recent territory-wide cohort study in Hong Kong [8], only 46% of respondents with high blood pressure received diagnosis. The treatment rate and control rate were only 70% and 42% among those diagnosed [8].

The study protocol conformed to the ethical guidelines of the Declaration of Helsinki. This study was approved by the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong.




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