The concept of individualized hypertension care in general practice and outpatient clinics. The general practitioner hypertension practice study (III).

OBJECTIVE

To examine test ordering practice among general practitioners and hospital medical specialists according to the concept of individualized hypertension care.

DESIGN

Mailed hypothetical case histories, with reference panels to categorize tests.

SETTING

Uppsala-Orebro region in mid-Sweden.

SUBJECTS

General practitioners (N = 90) and hospital medical specialists (N = 69) in randomly sampled primary health care centres and hospitals.

MAIN OUTCOME MEASURES

Test ordering scores.

RESULTS

84% of invited GPs and 72% of specialists participated. According to reference panel standards, primary care physicians performed 75% of obligatory tests and specialists 88%. Superfluous tests constituted a larger proportion of the practice of hospital specialists (11-28%) than GPs (2-12%) in the six cases. Summarized examination scores revealed a wide practice variation within and between the two physician categories, specialists scoring significantly higher in three cases. Standardization of practice was more common among specialists, and differed significantly regarding serum potassium test, chest X-ray and ECG. Both groups deviated from current guidelines by omitting metabolic parameters.

CONCLUSION

There is considerable practice variation in individualized hypertension care, which might influence treatment outcome. Practice audit and continuing medical education could contribute to care standardization according to guidelines.