Impact of changes to national guidelines on hypertension-related workload: an interrupted time series analysis in English primary care.
BACKGROUND: In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis.
AIM: To assess the impact of guideline change on rates of hypertension-related consultation in general practice.
DESIGN AND SETTING: A retrospective open cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1 April 2006 and 31 March 2017.
METHOD: The primary outcome was the rate of face-to-face, telephone, and home visit consultations related to hypertension with a GP or nurse. Age- and sex-standardised rates were analysed using interrupted time-series analysis.
RESULTS: In 3 937 191 adults (median follow-up 4.2 years) there were 12 253 836 hypertension-related consultations. The rate of hypertension-related consultation was 71.0 per 100 person-years (95% confidence interval [CI] = 67.8 to 74.2) in April 2006, which remained flat before 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend -3.60 per 100 person-years, 95% CI = -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI = 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis, and persisted when accounting for wider trends in all consultations.
CONCLUSION: Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.
|ジャーナル名||The British journal of general practice : the journal of the Royal College of General Practitioners|
|投稿者||Lay-Flurrie, Sarah L; Sheppard, James P; Stevens, Richard J; Mallen, Christian; Heneghan, Carl; Hobbs, Fd Richard; Williams, Bryan; Mant, Jonathan; McManus, Richard J|
|組織名||Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford.;School for Primary, Community and Social Care, Keele University, Staffordshire.;National Institute for Health Research (NIHR) University College London Hospitals;Biomedical Research Centre, Institute of Cardiovascular Science, University;College London, London.;Primary Care Unit, Department of Public Health & Primary Care, University of;Cambridge, Cambridge.|