[Diagnosis and treatment of hypertension prior to and following introduction of a protocol].
OBJECTIVE
To determine the compliance with and the outcome of a practice guideline introduced for the management of hypertension.


METHODS
Retrospective medical record survey.


METHODS
The outpatient clinic of general internal medicine of the Academic Medical Hospital Nijmegen, the Netherlands.


METHODS
Daily practice in a period before (1988) and one after (1993) implementation of the guideline were compared. By means of an inventory form we evaluated the compliance with the guideline, the decrease in blood pressure after 1 year's follow-up and the number and dosages of the prescribed drugs. Total costs were approximated from the number of visits and the number of laboratory and imaging evaluations.


RESULTS
Compliance with the guideline in 1993 was 72% (24) compared with 65% (27) in 1988. This improvement was predominantly achieved by the junior residents. In 1993 in 15 patients (19%) blood pressure was measured without medication having been stopped. The guideline regarding the frequency of blood pressure measurement was observed in 7 patients (9%). The decrease in systolic and diastolic blood pressure was larger in 1993 than in 1988 (p < 0.05). This result was achieved by a larger number of blood pressure lowering drugs (1.40 (1.06) in 1993 vs. 1.17 (0.98) in 1988): the mean dose of the prescribed drugs was lower. The number of visits rose by 10% to 7.8 (3.7) and the number of diagnostic laboratory procedures by 25% to 956.
Cools
B M
BM
Afd. Algemene Inwendige Geneeskunde, Academisch Ziekenhuis Nijmegen.
Kingma
K
K
Wollersheim
H
H
Lenders
J W
JW
de Vries Robbé
P
P
Thien
T
T
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D017281:Cost of Illness; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011787:Quality of Health Care; D012189:Retrospective Studies
D000959:Antihypertensive Agents