Cranney M, Barton S, Walley T
Department of Pharmacology and Therapeutics, University of Liverpool.
Br J Gen Pract. 1998 Jul;48(432):1424-8.
Hypertension is a common condition almost exclusively managed by general practitioners (GPs), making it an ideal subject for practice-based audit. However, the conduct and interpretation of such audits is complex. Even minor variations in methodology can produce dramatic differences in results obtained. We used a focus group of seven GPs with a special interest in audit to establish a standardized method for the planning and reporting of audits for the management of hypertension. In order to enhance the reliability and comparability of hypertension audits, 13 key areas of audit methodology were produced by the focus group. Eleven audits were identified in a literature search using pre-determined selection criteria. These were then assessed to compare their methodology with the criteria produced by the focus group. None of the recently published audits in this subject covered all of the key areas (range: 27-65% of the areas covered). One key area, that of digit preference, was not mentioned by any. Other problematic key areas included the selection of patient records without bias, the determination of the prevalence of hypertension, the number of recordings used to determine the diagnosis of hypertension and its subsequent control, the time period examined by the audit, and the approach taken to notes containing an inadequate number of blood pressure recordings. Significant variability in the methods used by different authors in these key areas calls into question the reliability of their results and makes comparisons between them very difficult. We propose a standardized method for hypertension audits comprising 13 key areas, which will enhance the reliability of results and facilitate such comparisons.
高血压是一种几乎完全由全科医生（GP）管理的常见病症，这使其成为基于实践的审计的理想对象。然而，此类审计的实施和解读很复杂。即使是方法上的微小差异也可能导致所得结果出现巨大差异。我们召集了一个由七名对审计有特别兴趣的全科医生组成的焦点小组，以建立一种用于高血压管理审计的规划和报告的标准化方法。为了提高高血压审计的可靠性和可比性，焦点小组确定了13个审计方法的关键领域。通过文献检索，使用预先确定的选择标准，确定了11项审计。然后对这些审计进行评估，以将其方法与焦点小组制定的标准进行比较。该主题最近发表的审计中没有一项涵盖所有关键领域（涵盖范围：所涉领域的27% - 65%）。其中一个关键领域，即数字偏好，没有任何一项审计提及。其他存在问题的关键领域包括无偏差地选择患者记录、确定高血压的患病率、用于确定高血压诊断及其后续控制的记录数量、审计所考察的时间段，以及对血压记录数量不足的记录的处理方法。不同作者在这些关键领域使用的方法存在显著差异，这让人质疑其结果的可靠性，并使得它们之间的比较非常困难。我们提出一种包含13个关键领域的高血压审计标准化方法，这将提高结果的可靠性并便于此类比较。
