Research Unit of General Practice, Institute of Public Health, University of Southern Denmark...
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Research Unit of General Practice, Institute of Public Health, University of Southern Denmark Hypertension in General Practice – an APO-audit Jens Damsgaard Peter Schultz-Larsen, Lene Reuther, Lars Poulsen, Dorte Gilså Hansen Jens Søndergaard, Morten Andersen & Anders Munck
description
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark Background Estimated persons in DK. (200 per GP) Half of them is diagnosed Half of them again is well treated Focus at the increasing lack of GP’s Need for more involvement of practice staff
Transcript of Research Unit of General Practice, Institute of Public Health, University of Southern Denmark...
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Hypertension in General Practice – an APO-audit
Jens Damsgaard Peter Schultz-Larsen, Lene Reuther, Lars Poulsen, Dorte Gilså Hansen Jens Søndergaard, Morten Andersen & Anders Munck
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Hypertension in General Practice
• Traditional APO-audit• Part of a randomised study with control group• Involvement of the patients through a questonaire• Half of the practices will get the intervention activities
after the second registration• The cohorte of patients answering can be followed in
various registers
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Background
• Estimated 800.000 persons in DK. (200 per GP)• Half of them is diagnosed• Half of them again is well treated
• Focus at the increasing lack of GP’s • Need for more involvement of practice staff
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Objectives
• to improve diagnosing • to improve treatment • to Improve monitoring
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Methods“Eye-opening” through an APO-audit
• collection of data in own practice • questionnaires to the patients • participation in follow-up courses
184 practices with at average two doctors and one nurse from each clinic enrolled 7342 patients
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Items• Duration• Blood pressure
in the clinic at home after self measurement
• Cardiovascular risk factors smoking, family history, hyperlipidemia,
diabetes and others• Cardiovascular events
Apoplexia and coronary trombosis,• Pharmacological treatment.
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Systolic blood pressure
0
10
20
30
40
50
60
70
80
90
100
100 110 120 130 140 150 160 170 180 190 200 230
mm Hg
Cumulated percent
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Duration of Hypertension
2224
50
5
0
10
20
30
40
50
60
Less than 2 years 2 - 5 years More than 5 years Not known
Percent of registrations
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Cardiovascular risc factors
32
22
42 42
35
1614
1
0
5
10
15
20
25
30
35
40
45
Heritability Smoking Hyper-cholesterolemia
Overweight Too littleexercise
Diabetes Others Unknown
Percent of registrations
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Complications in relation to age
5,1 4 5,7
79,9
10,3 7,612,3
67,2
010203040
5060708090
TCI/apoplexia Acute coronarysyndrome
Another complication None
Pt. <=65 years Pt. >65 years
Percent of registrations
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Treatment
2
2
3
27
33
24
42
59
11
0 10 20 30 40 50 60 70
Unknown
No treatment
Other antihypertensiv drugs
Beta-blockers
Ca-antagonists
AII- antagonist
ACE- inhibitors
Diuretics
Non-farmacological
Percent of registrations
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Treatment and cardiovascular complications
1,1
2
2,1
23,1
32
22,5
41,7
59,4
11,3
1,3
0,9
3,7
42,6
36,6
26,1
42,5
61,2
10,3
0 10 20 30 40 50 60 70
Unknown
No treatment
Other antihypertensive drugs
Beta-blockers
Ca-antagonists
AII- antagonists
ACE-inhibitors
Diuretics
Non-pharmacological
No complications One or more complication
Percent of registrations
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Number %
Yes 44 27,7No 113 71,1Unknown 2 1,3Sum 159 100,0
Do your practice have written guidelines for the examination of hypertensive patients?
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
12,6
79,9
55,3
60,4
56
27,7
23,3
67,9
69,2
0 20 40 60 80 100
Something else
Instruction in home measuring
Guidance concerning exercise
Guidance concerning diet
Smoking cessation activities
Interviews on compliance
Teaching about medicine and side effects
Weight controls
Blood pressure measuring
Percent of registrations
Staff involvement
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
The courses• Result from doctors registration• Result from the questionnaire• Result from prescription database• Treatment today• Management today• Measurement, calibration e.g. • Prevention activities at municipality level
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
Future
• Next registration is about to take place• Actual blood pressure – same patients
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark
www.apo-danmark.dk
