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Table 2 Barriers to prescribing thiazides for the treatment of hypertension, and possible interventions to address these

From: Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change

Possible barriers Possible interventions
Physicians are neither familiar with the relevant brand-names nor to the use and follow-up of these drugs - Pre-printed prescriptions, also in electronic format - Patient information - Support for the clinical follow-up
Few other clinicians use these drugs - Patient information - Active promotion of thiazides (through educational outreach visits) - Point out the consensus among guidelines that thiazides are a first-line drug
Specialists may be prescribing other drugs - Identify opinion leaders that advocate the use of thiazides - Look into possible conflicts of interest
Advocacy by pharmaceutical companies - Point attention to the importance of clinically relevant endpoints when studies are quoted (during educational outreach visits) - Review advertisements to identify the main lines of reasoning that are being used
Physicians are worried about possible side-effects and lack of anti-hypertensive effect. - Educational outreach visits
Thiazides considered old-fashioned - Argue that these drugs have been thoroughly tested over many years (during educational outreach visits)