Frijling B D, Spies T H, Lobo C M, Hulscher M E, van Drenth B B, Braspenning J C, Prins A, van der Wouden J C, Grol R P
Centre for Quality of Care Research, University of Nijmegen, P O Box 9101, 6500 HB Nijmegen, The Netherlands.
Br J Gen Pract. 2001 Jan;51(462):9-14.
The blood pressure of many treated hypertensive patients remains above recommended target levels. This discrepancy may be related to general practitioners' (GPs') actions.
To assess clinical performance of GPs in blood pressure control in treated hypertensive patients and to explore the influence of patient and GP characteristics on clinical performance.
Cross-sectional study conducted on 195 GPs with invitations to participate made via bulletins and by letter.
One hundred and thirty-two practices in the southern half of The Netherlands from November 1996 to April 1997.
Performance criteria were selected from Dutch national hypertension guidelines for general practice. GPs completed self-report forms immediately after follow-up visits of hypertensive patients treated with antihypertensive medication.
The GPs recorded 3526 follow-up visits. In 63% of these consultations the diastolic blood pressure (DBP) was 90 mmHg or above. The median performance rates of the GPs were less than 51% for most of the recommended actions, even at a DBP of > or = 100 mmHg. Performance of non-pharmacological actions increased gradually with increasing DBP; prescribing an increase in antihypertensive medication and making a follow-up appointment scheduled within six weeks rose steeply at a DBP of > or = 100 mmHg. Patient and GP characteristics contributed little to clinical performance. Action performance rates varied considerably between GPs.
GPs seem to target their actions at a DBP of below 100 mmHg, whereas guidelines recommend targeting at a DBP of below 90 mmHg.
许多接受治疗的高血压患者的血压仍高于推荐的目标水平。这种差异可能与全科医生（GP）的行为有关。
评估全科医生在控制接受治疗的高血压患者血压方面的临床表现，并探讨患者和全科医生特征对临床表 现的影响。
通过公告和信件邀请195名全科医生参与的横断面研究。
1996年11月至1997年4月期间荷兰南部的132家诊所。
从荷兰国家高血压全科诊疗指南中选取绩效标准。全科医生在对接受抗高血压药物治疗的高血压患者进 行随访后立即填写自我报告表。
全科医生记录了3526次随访。在这些会诊中，63%的患者舒张压（DBP）为90 mmHg或更高。对于大多 数推荐的措施，全科医生的绩效中位数低于51%，即使在DBP≥100 mmHg时也是如此。非药物措施的执行情 况随着DBP的升高而逐渐增加；在DBP≥100 mmHg时，增加抗高血压药物的处方和安排在六周内进行随访的 预约急剧增加。患者和全科医生的特征对临床绩效的影响很小。不同全科医生之间的措施执行率差异很大。
全科医生似乎将他们的行动目标设定为DBP低于100 mmHg，而指南建议目标是DBP低于90 mmHg。
