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Audit of use of ACE inhibitors and monitoring in general practice

BMJ 1999; 318 doi: (Published 19 June 1999) Cite this as: BMJ 1999;318:1697

Guidelines on monitoring, on their own, are not sufficient

  1. Nick Freemantle, Senior research fellow,
  2. James Mason, Senior research fellow,
  3. Martin Eccles, Professor of clinical effectiveness
  1. Medicines Evaluation Group, Centre for Health Economics, University of York, York YO10 5DD
  2. Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  3. Department of Renal Medicine, Hope Hospital, Salford M6 8HD
  4. Royal Preston Hospital, Preston PR2 9HT
  5. Department of Renal Medicine, Glan Clwyd Hospital, Rhyl LL18 5UJ
  6. National Primary Care Research and Development Centre, University of Manchester, Manchester M13 6PL

    EDITOR—Kalra et al's paper describing an audit of monitoring renal function in general practice suggests that practice is often less than optimal, although associated with some uncertainty.1 Unfortunately, the authors do not give confidence intervals around their estimates of effect—which we provide here. The fact that only 34% (95% confidence interval 28% to 39%) of practitioners checked renal function after initiating angiotensin converting enzyme inhibitors and 15% (11% to 19%) never checked it is an important finding. We disagree, however, with the authors' conclusion that producing guidelines on monitoring, on its own, will lead to an improvement in practice.

    The authors state that renal monitoring has been neglected in recent guidelines and cite the North of England evidence based guidelines on the use of angiotensin converting enzyme inhibitors in primary care (to which we contributed) …

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