Hypertension at North Street Medical Care Processes and Outcomes March 2001 Susan Neal / Stephen Newell

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Hypertension at North Street Medical
CareProcesses and OutcomesMarch 2001 Susan
Neal / Stephen Newell
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Introduction

• This audit reviews the features of the current
  known hypertensive patients at NSMC and the care
  they receive
• Some outcomes of that care are reviewed

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Aims of this discussion

• To review the current state of play
• To decide how the current provision of care
  should be delivered
• To consider what else we need to provide

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This audit looks at

• Record keeping
• Systems
• Processes
• Outcomes
• Results are both anonymised and identifiable
  depending on wishes of the group

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Record keeping systems

• Process of care by individual clinicians
• Accuracy of documentation
• Last 20 dedicated hypertension consultations

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Correct documentation

• Read code entry for hypertension clinic
• Use of hypertension template
• Recall date

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Results
total A B C D E F
HC entered 75 70 35 100 100 100 50
Template 70 55 5 100 100 100 60
Recall 61 40 35 100 100 90 0
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Results
total RJ RB ES SJ SN KF
HC entered 75 70 35 100 100 100 50
template 70 55 5 100 100 100 60
Recall 61 40 35 100 100 90 0
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Process

• As per protocol
• BP 6monthly
• Other parameters where not recorded in last 14
  months
• Action taken

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Total A B C D E F
BP 93 95 90 100 100 100 75
Weight 76 45 28 100 100 95 90
Smoking 56 44 0 80 100 90 17
UEs 74 25 83 100 66 100 71
Lipids 57 25 44 66 66 88 55
Action 80 87 25 100 88 100 80
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Total RJ RB ES SJ SN KF
BP 93 95 90 100 100 100 75
Weight 76 45 28 100 100 95 90
Smoking 56 44 0 80 100 90 17
UEs 74 25 83 100 66 100 71
Lipids 57 25 44 66 66 88 55
Action 80 87 25 100 88 100 80
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Patients with Hypertension

• Defined as
• On active hypertension register OR
• Read Code entry in medical history for
  hypertension OR
• Seen in hypertension clinic in the last 5 years

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Parameter in last 14m In clinic Total Outside clinic
BP recorded 100(815) 86 70(493)
No BP last 2 years 17
Weight 88(723) 60 26(186)
Smoking status 81(662) 55 26(182)
Fundi examined 71(582) 44 12(87)
UE 82(670) 45 12(15)
Uric acid if on thiazide 47(231)of 487 30 13(18) of 136
Blood glucose if on thiazide 12(62) of 487 11 10(13) of 136

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Last BP gt 150/90 31(260) 34 36(252)
Last BP gt160/100 6(47) 7 8(56)
BMI gt 30 31(228) 32 35 (66)
BMIgt 25 73 (529) 72 68(127)
Smokers 12(84) 14 26(182)
Cholesterol gt 5 mmols/l (82(495) 80 76(181)
On statin 17(85) 21 33(61)
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Medication No medication. 100(815) 0 78 (1182) 22 52(367) 32(226)
Not on medication last BP gt 150/90 BP gt 160/100 97 22
Last BP gt 150/90 What medications? 1 drug 46 2 drugs 40 3 drugs 11 4 drugs 1 1 drug 51 2 drugs 38 3 drugs 12 4 drugs nil
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Summary

• Half our known hypertensives are within the
  current clinic
• 86 have had a BP in the last 14 months, but only
  70 on non-clinic attenders
• 17 of these have had no BP for 2 years or more
• Over ¾ of our known hypertensives are on Rx
• Of those not on Rx, over half their last BP was
  outside current BHS guidelines
• A third of all known patients have BPs outside of
  current BHS targets
• Of these 12 are on 3 or more medications