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|Title:||The Detection and Management of Hypertension in Family Practice: A Practice Audit|
|Keywords:||hypertension;detection and management of hypertension;detection of hypertension;management of hypertension;family practice;practice audit|
|Abstract:||1.The prevalence of hypertension in the Stonechurch Family Health Centre (S.F.H.C.) was 18%. This is higher than the prevalence of 15% for Ontario (p-value <0.05).22 Using logistic regression analysis, age was highly significant (p-value <0.0001), while sex was not (p-value = 0.584). Another 10% had raised B.P. readings. While no patient had hypertension under the age of 30, the prevalence of hypertension rose dramatically to approximately 50% at age 70. 2. 34% of patients with diagnosed hypertension (and receiving medication) were not controlled. This is higher than values reported in other studies (27% & 19%).32,38 3. The controlled rate for treated patients 60 and older (64%) was higher than the rate for untreated patients 60 and older (22%) (p-value = 0.025). In particular, 80% of women under 60 were controlled compared with 53% for those 60 and older (higher, p-value = 0.046). 88% of the uncontrolled hypertension in the 60 and older group, was isolated systolic hypertension (I.S.H.). It appears that the clinic did not have a consistent policy for the management of I.S.H. in the elderly. Women were particularly affected. 4. 80% of women under 60 were controlled, compared to 57% for men under 60 (higher, p-value = 0.108). Strategies for improved surveillance and management are needed for men under the age of 60. 5. The implementation of health maintaining interventions for men appears problematic. 75% of women attended at least once in 1994, compared to only 64% of men (higher, p-value <0.05). Women attended much more (83%) during their child-bearing and child-rearing age. They visited more often, 3.9 visits/year compared to 2.9/year for men (higher, p-value< 0.05). During child-rearing age, the rate was 4.7 for women. While women attend for health maintenance (e.g. breast examinations, Pap smears, and contraception), there are no significant gender specific interventions for men. 6. 19% of men never had their B.P. taken, compared to only 8% of women (higher, p-value < 0.05). Using logistic regression analysis, both age and sex were highly significant (p-value < 0.0001). In the previous five years, at age 20, 54% of men and 18% of women, did not have their B.P. taken. 7. In the previous year only 44% of the practice had their B.P. taken (within two years: 61%; and five years: 80%). The clinic's 44% coverage for B.P. readings is lower than the 70-75% reported by others.29,32,33 Dunn reported that 83% of patients who visited their doctor in two years had their B.P. taken.34 8. While 82% of Canadians reported visiting a G.P. in the previous year, 70% of the S.F.H.C.'s patients visited in a year.22 There is a turnover of 84% in two years and 96% in five years. Therefore in general, opportunistic interventions could be run at two or five year cycles (coverage of 84% and 96% respectively). 9. 70% of patients used 100% of the services (visits) in a 1994. 27% of patients accounted for 70% of all visits to the S.F.H.C. 10. Recommendations are made to improve both provider and patient compliance. A Hypertension Flow Chart with accompanying management protocols derived from the Canadian Consensus on Hypertension Management 1984-1992, and a Coronary Artery Disease Risk Prediction Chart, are provided.25 It is an accessible up-to-date instrument for consistent and effective management. Family physicians are in the best possible position for on-going population surveillance, opportunistic intervention, early diagnosis, and management of hypertension.|
|Appears in Collections:||Digitized Open Access Dissertations and Theses|
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