Treatment intentions of general practitioners regarding hypertension in the oldest old: a vignette study

BACKGROUND The recent literature has shown that the risk of hypertension in the old strongly depends on their physical abilities. However, it is unknown whether general practitioners (GPs) adapt their treatment strategies to the patient's independence. This study was conducted to investigate the treatment intentions of GPs for patients aged 80 and older with hypertension in relation to the patients' level of dependency. METHODS A vignette study in Belgium. Flemish GPs (n = 305) were invited, directly or indirectly, by email to fill out a questionnaire, consisting of nine cases (three themes). In each theme, the level of dependency gradually increased. Per case, a score depending on the GP's treatment intention was calculated (range 0-3). The total score represented the 'Intention to Treat Hypertension in Older Persons' scale (ITHOP-scale). The difference between the score for robust patients and strongly dependent patients was calculated (delta score). RESULTS The scores on the ITHOP scale showed a mean of 15.2 ± 6.0. A significant difference in treatment intention was found between robust patients and strongly dependent patients. The delta score showed a mean of 1.7 ± 1.8. Differences between the GPs were responsible for 75 % of the variance of the total score, and differences in the level of dependency did not influence the variance (G coefficient =0.82). The GP's experience showed an inverse relationship to the total and the delta score. CONCLUSION Large differences in treatment intentions for hypertension in the very old exist between GPs, but the patient's level of dependency is not responsible for these differences.