Abstract
OBJECTIVE--To audit avoidable deaths from stroke and hypertensive disease. DESIGN--Details of care before death were obtained from general practitioners and other doctors, anonymised, and assessed by two experts against agreed minimum standards of good practice for detecting and managing hypertension. SETTING--Health authority with population of 250,000. SUBJECTS--All patients under 75 years who died of stroke, hypertensive disease, or hypertension related causes during November 1990 to October 1991. MAIN OUTCOME MEASURES--Presence of important avoidable factors and departures from minimum standards of good practice. RESULTS--Adequate information was obtained for 88% (123/139) of eligible cases. Agreement between the assessors was mostly satisfactory. 29% (36/123, 95% confidence interval 21% to 37%) of all cases and 44% (36/81, 34% to 55%) of those with definite hypertension had avoidable factors that may have contributed to death. These were most commonly failures of follow up and continuing smoking. Assessment against standards of minimum good practice showed that care was inadequate but not necessarily deemed to have contributed to death, in a large proportion of patients with definite hypertension. Common shortcomings were inadequate follow up, clinical investigation, and recording of smoking and other relevant risk behaviours. CONCLUSIONS--This method of audit can identify shortcomings in care of patients dying of hypertension related disease.
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Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Chapman A., Ridout S. Hypertensive care and the small practice. Practitioner. 1989 Jul 8;233(1472):1018–1022. [PubMed] [Google Scholar]
- Collins R., Peto R., MacMahon S., Hebert P., Fiebach N. H., Eberlein K. A., Godwin J., Qizilbash N., Taylor J. O., Hennekens C. H. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990 Apr 7;335(8693):827–838. doi: 10.1016/0140-6736(90)90944-z. [DOI] [PubMed] [Google Scholar]
- DOLL R., HILL A. B. MORTALITY IN RELATION TO SMOKING: TEN YEARS' OBSERVATIONS OF BRITISH DOCTORS. Br Med J. 1964 May 30;1(5395):1399–1410. doi: 10.1136/bmj.1.5395.1399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gill J. S., Zezulka A. V., Shipley M. J., Gill S. K., Beevers D. G. Stroke and alcohol consumption. N Engl J Med. 1986 Oct 23;315(17):1041–1046. doi: 10.1056/NEJM198610233151701. [DOI] [PubMed] [Google Scholar]
- Gordon T., Kannel W. B. Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. JAMA. 1972 Aug 14;221(7):661–666. [PubMed] [Google Scholar]
- Hall J. A. Audit of screening for hypertension in general practice. J R Coll Gen Pract. 1985 May;35(274):243–243. [PMC free article] [PubMed] [Google Scholar]
- Kurji K. H., Haines A. P. Detection and management of hypertension in general practices in north west London. Br Med J (Clin Res Ed) 1984 Mar 24;288(6421):903–906. doi: 10.1136/bmj.288.6421.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mant D., McKinlay C., Fuller A., Randall T., Fullard E. M., Muir J. Three year follow up of patients with raised blood pressure identified at health checks in general practice. BMJ. 1989 May 20;298(6684):1360–1362. doi: 10.1136/bmj.298.6684.1360. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Michael G. Quality of care in managing hypertension by case finding in north west London. Br Med J (Clin Res Ed) 1984 Mar 24;288(6421):906–908. doi: 10.1136/bmj.288.6421.906. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ritchie L. D., Currie A. M. Blood pressure recording by general practitioners in north-east Scotland. Br Med J (Clin Res Ed) 1983 Jan 8;286(6359):107–109. doi: 10.1136/bmj.286.6359.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shaper A. G., Phillips A. N., Pocock S. J., Walker M., Macfarlane P. W. Risk factors for stroke in middle aged British men. BMJ. 1991 May 11;302(6785):1111–1115. doi: 10.1136/bmj.302.6785.1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith W. C., Lee A. J., Crombie I. K., Tunstall-Pedoe H. Control of blood pressure in Scotland: the rule of halves. BMJ. 1990 Apr 14;300(6730):981–983. doi: 10.1136/bmj.300.6730.981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Taffinder A. P., Taffinder G. A. An audit of hypertension in general practice. Practitioner. 1984 Jun;228(1392):595–598. [PubMed] [Google Scholar]
- Wilson J. B. An audit of hypertension in a rural practice. Practitioner. 1978 May;220(1319):689–692. [PubMed] [Google Scholar]