Abstract
BackgroundIn 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.AimTo assess the impact of guideline change on rates of hypertension-related consultation in general practice.Design and settingA 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.MethodThe 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.ResultsIn 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.ConclusionHypertension-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.
Highlights
Primary care workload in England increased by 16% between 2007 and 2014, with primary care appearing to reach saturation point.[1]
The introduction of the National Institute for Health and Care Excellence (NICE) hypertension guideline in 2011 was associated with a change in yearly trend
Hypertension-related workload has declined in the last decade, in association with guideline changes
Summary
Primary care workload in England increased by 16% between 2007 and 2014, with primary care appearing to reach saturation point.[1]. The 2011 National Institute for Health and Care Excellence (NICE) hypertension guideline introduced recommendations for the diagnosis of hypertension that included the use of out-of-office measurement for confirmation of an initially raised clinic blood pressure (BP).[5] This change was in response to concerns that using clinic BP may result in approximately 25% of individuals being misclassified due to white coat hypertension.[6] The changes were predicted to reduce workload due to a reduction in the unnecessary treatment of white coat hypertension.[5]. 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
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