INTERPRACTICE AUDIT OF DIAGNOSIS AND MANAGEMENT OF HYPERTENSION IN PRIMARY-CARE - EDUCATIONAL INTERVENTION AND REVIEW OF MEDICAL RECORDS

Objective: To determine whether peer review medical audit in a primary care setting changes clinical behaviour in relation to the management of hypertension. Design: Review of medical records in general practic es to identify hypertensive patients followed up by assessment of the pre-educational and post-educational management of interventions. Sett ing: Six general practices in north west London picked at random withi n defined criteria of geography and size. Subjects: 740 hypertensive p atients managed by 25 different general practitioners. Main outcome me asures:Improved level of care in terms of better diagnosis by having a t least three blood pressure readings before the start of drug treatme nt, better level of recordings of lifestyle parameters as shown by the level of recordings of body mass index and total lipid values, and be tter control of blood pressure and harm minimisation as shown by the l evel of recordings of urea and electrolyte values. Results:Improvement was noted in the level of recordings of body mass index, total lipid concentrations, and urea and electrolyte values but not in better diag nosis or blood pressure control. Conclusion: Clinical behaviour of gen eral practitioners can be changed by peer review but more complex beha vioural changes which require the cooperation of the patients and cogn itive actions by the general practitioners need further investigation.