Interpractice audit of diagnosis and management of hypertension in primary care: educational intervention and review of medical records

Abstract

Objective: To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension.

Design: Review of medical records in general practices to identify hypertensive patients followed up by assessment of the pre-educational and post-educational management of interventions.

Setting: Six general practices in north west London picked at random within defined criteria of geography and size.

Subjects: 740 hypertensive patients managed by 25 different general practitioners.

Main outcome measures: Improved level of care in terms of better diagnosis by having at least three blood pressure readings before the start of drug treatment, better level of recordings of lifestyle parameters as shown by the level of recordings of body mass index and total lipid values, and better control of blood pressure and harm minimisation as shown by the level of recordings of urea and electrolyte values.

Results: Improvement was noted in the level of recordings of body mass index, total lipid concentrations, and urea and electrolyte values but not in better diagnosis or blood pressure control.

Conclusion: Clinical behaviour of general practitioners can be changed by peer review but more complex behavioural changes which require the cooperation of the patients and cognitive actions by the general practitioners need further investigation.