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General Practice

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

BMJ 1997; 314 doi: (Published 29 March 1997) Cite this as: BMJ 1997;314:942
  1. Mahendra Mashru, North Thames clinical research fellow in general practicea,
  2. Ariel Lanta, professor
  1. Department of Clinical Pharmacology and Therapeutics Charing Cross and Westminster Medical School Chelsea and Westminster Hospital London SW10 9NH
  1. Correspondence to: Dr Mahendra Mashru 19 King Edward's Road Ruislip Middlesex HA4 7AG.
  • Accepted 24 January 1997


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.

Key messages

  • Peer review can significantly change the clinical behaviour of general practitioners with respect to undertaking simple diagnostic procedures, recording lifestyle variables, and carrying out laboratory measurements

  • Attempts to improve control of blood pressure by general practitioners is a target less easily achieved

  • A primary care study has shown that despite an active education programme over two years the proportion of treated patients whose blood pressure was controlled to <160/90 mm Hg remained at only one third


    • Accepted 24 January 1997
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