title: Improving management of hypertension in general practice: a randomised controlled trial of feedback derived from electronic patient data.
abstract: BACKGROUND
  Although absolute risk of death associated with raised blood pressure increases with age, the benefits of treatment are greater in older patients. However, fewer patients in this group are identified, treated, and controlled.
  
  
  OBJECTIVE
  To evaluate the impact of the provision of different levels of feedback on identification, treatment, and control of older patients with hypertension.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Fifty-two Scottish general practices.
  
  
  METHODS
  Practices were randomly allocated to either control (n = 19), audit only feedback (n = 16), or audit plus risk feedback, prioritising patients by absolute risk (n = 17). Electronic data were extracted from practice computer systems annually from 1999 to 2001 and used to develop feedback. Data were collected for 30 345 patients aged 65-79 years.
  
  
  RESULTS
  The majority of known patients with hypertension in each group had an initial blood pressure recorded (control = 89.6%; audit = 80.4%; risk = 96.1%) and this increased over the study period (control = 92.3%; audit = 86.0%; risk = 96.6%). Initially, more than 80% of patients in each group were treated but many were uncontrolled (blood pressure >/=160/ >/=90 mmHg) (control = 41.5%; audit = 41.3%; risk = 36.1%). The numbers of untreated and uncontrolled patients in each group reduced (control = 32.3%; audit = 38.3%; risk = 32.6%). There was some evidence of a significant difference in mean systolic pressure between the audit plus risk and audit only groups: (149.6 versus 152.7 mmHg; P = 0.019) and of significantly greater control in the audit plus risk group compared with the other groups 49.4% (versus audit only = 35.4%; versus control = 46.5%; odds ratio = 1.72 [95% confidence interval = 1.09 to 2.70]; P = 0.019).
  
  
  CONCLUSIONS
  Levels of identification, treatment, and control improved in each group. Although there were still significant numbers of patients with uncontrolled hypertension, there is some evidence to suggest that providing patient-specific feedback may have a positive impact on identification and management of hypertension in older people and produce an increase in control.
authors.affiliation: Tayside Centre for General Practice, University of Dundee, Dundee. e.d.mitchell@chs.dundee.ac.uk
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mitchell
authors.forename: Frank
authors.initials: F
authors.lastname: Sullivan
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: Peter T
authors.initials: PT
authors.lastname: Donnan
authors.forename: Graham
authors.initials: G
authors.lastname: Watt
mesh_terms: D000368:Aged; D001794:Blood Pressure; D005194:Family Practice / Q000592:standards; D005246:Feedback; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008485:Medical Audit; D008490:Medical Informatics; D016347:Medical Records Systems, Computerized; D012606:Scotland
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