Individual variation between general practitioners in labelling of hypertension.

Smith, Tristan; Clayton, David

doi:10.1136/bmj.300.6717.74

Cited by 12 publications

(5 citation statements)

References 2 publications

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“…These results confirm that significant variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with diastolic hypertension or isolated systolic hypertension. The reasons for variability between individual doctors is unclear but the variation is similar to that observed with the management of younger hypertensives [11][12][13][14]. This indicates that variabilty between doctors in the threshold at which they would treat sustained hypertension is unlikely to be solely explained by differing ageist attitudes, although good evidence exists that thrombolytic therapy for acute myocardial infarction is frequently denied to patients on the basis of age alone [15].…”

Section: Discussionmentioning

confidence: 99%

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford

Asghar

1995

Brit J Clinical Pharma

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1 The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2 Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3 Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4 Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. These results suggest that effective interventions in addition to guidelines need to be developed if hypertension in the elderly is to be consistently managed.

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Section: Discussionmentioning

confidence: 99%

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford

Asghar

1995

Brit J Clinical Pharma

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“…We sought studies published in English, or with an English abstract, between 1980 and July 1995 owing to the lesser relevance of earlier studies. Studies were excluded if they did not explicitly refer to drug treatments,12 13 14 15 as in diabetic care16 17 18 19 20 21 22 23 24; if they referred to prescribers' knowledge of and attitudes towards prescribing rather than their prescribing practices25 26 27 28 29 30; if they did not make clear the doctor's prescribing role in shared care arrangements31 32 or after discharge of patients from hospital33; or if they had poor or uncertain validity because information on appropriateness was unclear34 35 36 or unsupported by the British National Formulary 37 38 39…”

Section: Methodsmentioning

confidence: 99%

Prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom, 1980-95: systematic literature review

Buetow

Sibbald

et al. 1996

BMJ

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Objective-To determine the prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom.Design-Review of 62 studies of the appropriateness of prescribing identified from seven electronic databases, from reference lists, and by hand searching ofjournals. A nominal group of 10 experts helped to define the appropriateness of prescribing.Setting-General practice in the United Kingdom.Main outcome measures-Prevalences of 19 indicators of inappropriate long term prescribing representing five dimensions: indication, choice of drug, drug administration, communication, and review.Results-Prevalences ofpotentially inappropriate prescribing varied by indicator and chronic condition, but drug dosages outside the therapeutic range consistently recorded the highest rates. The lowest rates were generally associated with indicators of the choice of the drug, except cost minimisation. Communication is studied less frequently than other dimensions of prescribing appropriateness.Conclusions-The evidence base to support allegations of widespread inappropriate prescribing in general practice is unsound. Although inappropriate prescribing has occurred, the scale of the problem is unknown because oflimitations associated with selection of a standard, publication bias, and uncertainty about the context of prescribing decisions. Opportunities for cost savings and effectiveness gains are thus unclear. Indicators applicable to individual patients could yield evidence ofprescribing appropriateness.

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“…Despite the considerable resources devoted to promoting the use of new evidence by clinicians, translating clinical and health services research findings into routine clinical practice is an unpredictable and often slow process. This phenomenon is apparent across different healthcare settings, specialties and countries, including the UK, [ 1 - 5 ] other parts of Europe [ 4 ] and the USA [ 5 , 6 ], with obvious implications for the quality of patient care.…”

Section: Introductionmentioning

confidence: 99%

Developing the content of two behavioural interventions: Using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

Hrisos

Eccles

Johnston

et al. 2008

BMC Health Serv Res

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Background: Evidence shows that antibiotics have limited effectiveness in the management of upper respiratory tract infection (URTI) yet GPs continue to prescribe antibiotics. Implementation research does not currently provide a strong evidence base to guide the choice of interventions to promote the uptake of such evidence-based practice by health professionals. While systematic reviews demonstrate that interventions to change clinical practice can be effective, heterogeneity between studies hinders generalisation to routine practice. Psychological models of behaviour change that have been used successfully to predict variation in behaviour in the general population can also predict the clinical behaviour of healthcare professionals. The purpose of this study was to design two theoretically-based interventions to promote the management of upper respiratory tract infection (URTI) without prescribing antibiotics.

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Individual variation between general practitioners in labelling of hypertension.

Abstract: Measuring the incidence ot acute mnocardial intfarction: the problem of possible acute msocardial infarction.

Cited by 12 publications

References 2 publications

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Prevalence of potentially inappropriate long term prescribing in general practice in the United Kingdom, 1980-95: systematic literature review

Developing the content of two behavioural interventions: Using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

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