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The management of severe hypertension in Australian general practice.

Gallego B, Runciman WB, Perez-Concha O, Liaw ST, Day RO, Dunn AG, Coiera E - BMC Health Serv Res (2013)

Bottom Line: Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics.Some clinics showed better performance.Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia. b.gallego@unsw.edu.au.

ABSTRACT

Background: Severe hypertension (SHT) (Blood Pressure, BP ≥ 180/110 mmHg) is associated with considerable morbidity and mortality, yet little is known about how it is managed. The purpose of this study is to examine the management of SHT by Australian general practitioners (GPs) and to explore its variance across patient characteristics and clinical practices.

Methods: Review of electronic medical records for a year before and after a recorded measure of SHT in 7,499 patients by 436 GPs in 167 clinics throughout Australia during 2008-2009. Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range--sustained normotension).

Results: Of 7,499 patients with an electronic BP record of SHT, 94% were followed up (median time 14 days); 8% were referred to an appropriate specialist (median time 89 days--2% within 7 days) and 86% were managed by GPs. GPs initiated or changed antihypertensive drugs in 5,398 patients (72% of cohort); of these, 46% remained hypertensive (4% with SHT) and 7% achieved sustained normotension; 6% had no further electronic BP records. The remaining 14% had no medication changes; among these, 43% remained hypertensive (5% with SHT) and 3% achieved sustained normotension; 32% had no further electronic BP records. Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics.

Conclusions: Most patients with SHT had at least one follow-up visit and 72% had initiation of, or changes to, antihypertensive drug treatment. Although most of the patients experienced some improvement, blood pressure control was poor. Some clinics showed better performance. Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

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Related in: MedlinePlus

Times to follow-up, referral, a normotensive reading and sustained normotension during the study year. Percentages are calculated with respect to the full cohort of 7,499 patients. Shaded areas correspond to 50% of patients (median time).
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Figure 2: Times to follow-up, referral, a normotensive reading and sustained normotension during the study year. Percentages are calculated with respect to the full cohort of 7,499 patients. Shaded areas correspond to 50% of patients (median time).

Mentions: Most of the 7,499 patients (94%) had a follow-up visit with a median of 14 days (see Figure 2); 66% of these patients visited more than one doctor within the same practice. Referral to an appropriate specialist took place in 8% of patients after a median of 89 days – 2% within 7 days (see Figure 2). The remaining 6,416 patients (86%) were managed solely by GPs. Older, diabetic patients or patients with previous SHT episodes were more likely to be referred to specialists.


The management of severe hypertension in Australian general practice.

Gallego B, Runciman WB, Perez-Concha O, Liaw ST, Day RO, Dunn AG, Coiera E - BMC Health Serv Res (2013)

Times to follow-up, referral, a normotensive reading and sustained normotension during the study year. Percentages are calculated with respect to the full cohort of 7,499 patients. Shaded areas correspond to 50% of patients (median time).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3852715&req=5

Figure 2: Times to follow-up, referral, a normotensive reading and sustained normotension during the study year. Percentages are calculated with respect to the full cohort of 7,499 patients. Shaded areas correspond to 50% of patients (median time).
Mentions: Most of the 7,499 patients (94%) had a follow-up visit with a median of 14 days (see Figure 2); 66% of these patients visited more than one doctor within the same practice. Referral to an appropriate specialist took place in 8% of patients after a median of 89 days – 2% within 7 days (see Figure 2). The remaining 6,416 patients (86%) were managed solely by GPs. Older, diabetic patients or patients with previous SHT episodes were more likely to be referred to specialists.

Bottom Line: Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics.Some clinics showed better performance.Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney 2052, Australia. b.gallego@unsw.edu.au.

ABSTRACT

Background: Severe hypertension (SHT) (Blood Pressure, BP ≥ 180/110 mmHg) is associated with considerable morbidity and mortality, yet little is known about how it is managed. The purpose of this study is to examine the management of SHT by Australian general practitioners (GPs) and to explore its variance across patient characteristics and clinical practices.

Methods: Review of electronic medical records for a year before and after a recorded measure of SHT in 7,499 patients by 436 GPs in 167 clinics throughout Australia during 2008-2009. Outcome measures included follow-up, referral, changes to antihypertensive drug treatment, and BP control (normotensive reading, BP < 140/90 mmHg, and whether subsequent recorded measures were also in the normal range--sustained normotension).

Results: Of 7,499 patients with an electronic BP record of SHT, 94% were followed up (median time 14 days); 8% were referred to an appropriate specialist (median time 89 days--2% within 7 days) and 86% were managed by GPs. GPs initiated or changed antihypertensive drugs in 5,398 patients (72% of cohort); of these, 46% remained hypertensive (4% with SHT) and 7% achieved sustained normotension; 6% had no further electronic BP records. The remaining 14% had no medication changes; among these, 43% remained hypertensive (5% with SHT) and 3% achieved sustained normotension; 32% had no further electronic BP records. Some outcome measures displayed a variance across GP clinics that was mostly unexplained by patient or practice characteristics.

Conclusions: Most patients with SHT had at least one follow-up visit and 72% had initiation of, or changes to, antihypertensive drug treatment. Although most of the patients experienced some improvement, blood pressure control was poor. Some clinics showed better performance. Suggestions are made for the development of clinical standards to facilitate appropriate management of this dangerous condition.

Show MeSH
Related in: MedlinePlus