Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices

Matthys, Jan; Meyere, Marc De; Mervielde, Ivan; Knottnerus, J. A.; Hond, Elly Den; Staessen, Jan A.; Duprez, Daniel; Maeseneer, Jan De

doi:10.1038/sj.jhh.1001744

Cited by 14 publications

(10 citation statements)

References 27 publications

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“…Training provided definitions with a mean age of 50.9 years (standard deviation [SD] 7.5 years, range 31-65 years). GPs had a mean of 17 trainees in the past; 29 see Table 1 for characteristics of the patients and doctors for the new contacts and follow-up contacts.…”

Section: Preparation Of the Students For Recording Icementioning

confidence: 99%

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Matthys¹,

Elwyn²,

Nuland³

et al. 2009

Br J Gen Pract

108

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BackgroundAlthough studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. AimTo evaluate the presence of ICE and its relation to medication prescription. Design of studyCross-sectional study. SettingThirty-six GP teaching practices affiliated with the University of Ghent, in Flanders, Belgium. MethodParticipants were all patients consulting on 30 May 2005, and their doctors. Reasons for an encounter (consultation or home visit) with new and follow-up contacts, the identification of ICE, and the prescription of medication were recorded by 36 trainee GPs undergoing observational training. The study included 613 consultations. ResultsOne, two, or three of the ICE components were expressed in 38.5%, 24.4%, and 20.1% (n = 236, 150, 123) of contacts respectively. On the other hand, in 17.0% (104/613) of all contacts, and in 22% (77/350) of the new contact reasons, no ICE was voiced, and the GPs operated without knowing this information about the patients. Mean number of ICE components per doctor and per contact was 1.54 (standard deviation = 0.54). A logistic regression analysis of the 350 new contacts showed that the presence of concerns (P = 0.037, odds ratio [OR] 1.73, 95% confidence interval [CI] = 1.03 to 2.9), and expectations (P = 0.009, OR = 2.0, 95% CI = 1.2 to 3.4) was associated with not prescribing new medication (dichotomised into the categories present/absent); however, other patient, doctor, and student variables were not significantly associated with medication prescription. ConclusionAn association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.

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Section: Preparation Of the Students For Recording Icementioning

confidence: 99%

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Matthys¹,

Elwyn²,

Nuland³

et al. 2009

Br J Gen Pract

108

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“…Each doctor performed the assessment in isolation and no observer was allowed during the procedure to prevent the patient's BP elevation 16 . All the clinical measurements were obtained in the morning between 11 AM and 12 PM.…”

Section: Reproducibilitymentioning

confidence: 99%

Teste de respiração lenta aumenta a suspeita da hipertensão do avental branco no consultório

Thalenberg¹,

Póvoa²,

Bombig³

et al. 2008

Arq. Bras. Cardiol.

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“…The presence of a final-year medical student during examination, 3 the prospect of a blood test being taken 4 and an insufficient rest period before measurement 5 can all increase the observed BP. An inadequate cuff size 6 and various other factors such as cold, pain or a full bladder 7 can also affect the measured BP.…”

Section: Introductionmentioning

confidence: 99%

Variation in recorded blood pressure terminal digit bias in general practice

2007

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This study aims to identify the extent of terminal digit bias in routinely recorded blood pressures (BP) across a number of different general practices and report on changes in terminal digit bias over a 10-year period. It also explores the effect this may have had on the mean recorded BP in this population. BP records were taken from The Health Improvement Network database containing anonymized patient records from information entered by UK general practices in the financial years 1996-1997 to [2005][2006]. The proportion of measurements ending in zero and the mean BP readings were calculated for each practice and for each year of data. Over this 10-year period the percentage of systolic BPs with zero terminal digits fell from 71.2 to 36.7% and mean recorded BP fell from 152.3 to 145.3 mm Hg. Correcting the BPs to remove terminal digit bias indicates a 2-3 mm Hg underestimation of the mean population systolic BP over this period. The between-practice variation in the percentage of zero terminal digit readings increased from 3.5 to 6.5 s.d. Although it is welcome to see a reduction in terminal digit bias, it is worrying to see the increase in variation between practices. There is evidence that terminal digit bias may lead to potential misclassification and inappropriate treatment of hypertensive patients. The increase in variation observed may therefore lead to an increased variation in the quality of care given to patients.

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Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices

Cited by 14 publications

References 27 publications

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Teste de respiração lenta aumenta a suspeita da hipertensão do avental branco no consultório

Variation in recorded blood pressure terminal digit bias in general practice

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