Adherence to drug therapy for hypertensive disorders of pregnancy: a cross-sectional survey

BACKGROUND: Hypertensive disorders of pregnancy (HDPs) are a major contributor to maternal mortality worldwide, and drug therapy for HDPs is complicated and special. Clinical guidelines help physicians optimize the care for HDPs, but little is known about whether physicians adhere to drug therapy guidelins well, especially in China. This study aims to evaluate adherence to the drug therapy guidelines of the Chinese Obstetricians and Gynecologists Association (COGA) for HDPs and to explore the corresponding associations with recommendation evidence. METHODS: A cross-sectional design was executed for 306 women with HDPs hospitalized in a maternity ward of a tertiary hospital from August 2014 to July 2015 in Hubei, China. Adherence to the COGA guidelines was evaluated according to six items: the time of use and route of administration and dosage of antihypertensive drugs, MgSO(4), and corticosteroids. Binary logistic regression was adopted to explore the associations between adherence to clinical decisions and recommendation evidence. RESULTS: The average adherence rate for drug therapy for HDPs was 48.22%. The adherence rate for the time of antihypertensive drug and corticosteroid use scored 95.65 and 86.75%, whereas the other four items of the time of MgSO(4) use and the routes of administration and dosages of antihypertensive drugs, MgSO(4), and corticosteroids scored < 50.00%. High- and low-evidence-based recommendations were followed in 40.00 and 54.70% of the decisions, respectively. Logistic regression revealed that recommendation evidence (OR = 0.588, P = 0.003) was associated with adherence. CONCLUSIONS: Further improvement is still needed to achieve good adherence, especially regarding the time of MgSO(4) use and drug dosage. High-evidence-based management of drug therapy for HDPs should be strengthened.