Standards for quality care of hypertensive patients in office and hospital practice

Abstract

This report contains the recommendations of the Committee on Hypertension of the Experimental Medical Care Review Organization of the Albemarle County Medical Society, Charlottesville, Va. on the care of patients with hypertension. The Society uses an epidemiologic approach to set standards for medical care. The Committee has made recommendations for primary prevention, case finding, diagnostic workup, therapy and follow-up procedures. After a study of office and hospital practices, standards of care were distributed and discussed in workshops. These criteria were then adopted by the County Medical Society as the standards for care of patients with high blood pressure. A new survey will be made to determine the effect of physician education on the care of these patients. The Committee recommends that efforts be made to have obese patients lose weight. Physicians of every specialty are to record the blood pressure on the initial visit of each new adult patient. Blood pressure is to be recorded in children once before age 6 and every 2 years thereafter, until age 15. All adult patients should have blood pressure checked and recorded annually. Physicians who do not have primary care of the hypertensive patient are responsible for informing and referring him. Those with primary responsibility are to render care according to these standards. Quality care of the hypertensive patient includes case finding, documentation of sustained hypertension, obtaining pertinent medical history and physical examination. Laboratory procedures include determinations of serum uric acid, blood urea nitrogen or creatinine, glucose, potassium, urinalysis, chest roentgenogram, urinary vanillylmandelic acid (VMA), free catechols or metanephrines, hematocrit, and white blood cell count. Other laboratory procedures are considered special studies. Successful therapy is defined as reducing blood pressure to normal with either surgery or drugs. Patients should be followed up at 3 month intervals after blood pressure is controlled. When quality care cannot be rendered the priorities of care in descending order are: case finding, drug therapy and follow-up, and diagnostic evaluation. This report contains the recommendations of the Committee on Hypertension of the Experimental Medical Care Review Organization of the Albemarle County Medical Society, Charlottesville, Va. on the care of patients with hypertension. The Society uses an epidemiologic approach to set standards for medical care. The Committee has made recommendations for primary prevention, case finding, diagnostic workup, therapy and follow-up procedures. After a study of office and hospital practices, standards of care were distributed and discussed in workshops. These criteria were then adopted by the County Medical Society as the standards for care of patients with high blood pressure. A new survey will be made to determine the effect of physician education on the care of these patients. The Committee recommends that efforts be made to have obese patients lose weight. Physicians of every specialty are to record the blood pressure on the initial visit of each new adult patient. Blood pressure is to be recorded in children once before age 6 and every 2 years thereafter, until age 15. All adult patients should have blood pressure checked and recorded annually. Physicians who do not have primary care of the hypertensive patient are responsible for informing and referring him. Those with primary responsibility are to render care according to these standards. Quality care of the hypertensive patient includes case finding, documentation of sustained hypertension, obtaining pertinent medical history and physical examination. Laboratory procedures include determinations of serum uric acid, blood urea nitrogen or creatinine, glucose, potassium, urinalysis, chest roentgenogram, urinary vanillylmandelic acid (VMA), free catechols or metanephrines, hematocrit, and white blood cell count. Other laboratory procedures are considered special studies. Successful therapy is defined as reducing blood pressure to normal with either surgery or drugs. Patients should be followed up at 3 month intervals after blood pressure is controlled. When quality care cannot be rendered the priorities of care in descending order are: case finding, drug therapy and follow-up, and diagnostic evaluation.