Levels of detection of hypertension in primary medical care and interventions to improve detection: a systematic review of the evidence since 2000
| Autor: | John Bankart, Keith Nockels, Richard Baker, Priya Modi, Andrew Wilson, Shona Agarwal |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
hypertension Population detection MEDLINE Ethnic group Psychological intervention 030204 cardiovascular system & hematology primary care 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine education Intensive care medicine Socioeconomic status Randomized Controlled Trials as Topic education.field_of_study Primary Health Care Mortality Premature business.industry Research Public health public health General Medicine Study heterogeneity General practice / Family practice business Qualitative research |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| Popis: | ObjectivesIn England, many hypertensives are not detected by primary medical care. Higher detection is associated with lower premature mortality. We aimed to summarise recent evidence on detection and interventions to improve detection in order to inform policies to improve care.DesignData sources: systematic review of articles published since 2000. Searches of Medline and Embase were undertaken. Eligibility criteria: published in English, any study design, the setting was general practice and studies included patients aged 18 or over. Exclusion criteria: screening schemes, studies in primary care settings other than general practice, discussion or comment pieces. Participants: adult patients of primary medical care services. Synthesis: study heterogeneity precluded a statistical synthesis, and papers were described in summary tables.ResultsSeventeen quantitative and one qualitative studies were included. Detection rates varied by gender and ethnic group, but longitudinal studies indicated an improvement in detection over time. Patient socioeconomic factors did not influence detection, but living alone was associated with lower detection. Few health system factors were associated with detection, but in two studies higher numbers of general practitioners per 1000 population were associated with higher detection. Three studies investigated interventions to improve detection, but none showed evidence of effectiveness.LimitationsThe search was limited to studies published from 2000, in English. There were few studies of interventions to improve detection, and a meta-analysis was not possible.Conclusions and implicationsLevels of detection of hypertension by general practices may be improving, but large numbers of people with hypertension remain undetected. Improvement in detection is therefore required, but guidance for primary medical care is not provided by the few studies of interventions included in this review. Primary care teams should continue to use low-cost, practical approaches to detecting hypertension until evidence from new studies of interventions to improve detection is available. |
| Databáze: | OpenAIRE |
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