Utilising Practice Management System Data for Quality Improvement in Use of Blood Pressure Lowering Medications in General Practice

Abstract

AIM: To assess use of Electronic Medical Records (EMRs) to identify patient cases for potential quality improvement in use of blood pressure-lowering medications in general practice. SETTING: One metropolitan general practice in Auckland with a high proportion of Pacific patients. PARTICIPANTS: Patients registered as regular patients with the practice; classified within the previous 5 years as having hypertension; with at least one prescription for antihypertensive medication in the year prior to the evaluation period of 9 May to 8 November 2007. INTERVENTION: Iterative discussion of quality improvement opportunities and review of EMRs with a panel of practice clinicians to identify agreed quality indicators based on EMR data. This resulted in a set of eight evidence-based criteria for patients classified with hypertension, implemented as database queries, which identify cases for potential quality improvement. The panel conducted blind assessment of antihypertensive therapy on a sample of 20 cases matching at least one criterion and 20 cases that met no criterion; the case classifications based on the database queries were then revealed for direct comment and consideration by the panel. RESULTS: Of 517 eligible patients, 209 (40.4%) met one or more of the eight criteria. Of these 209, 110 (21.3%) met only criteria related to persistence of medication possession and/or blood pressure recording. After assessment of the 40-patient sample by the practice GPs, the eight criteria taken as a whole had a Positive Predictive Value of 70% (95% CI 46-88%) and Negative Predictive Value of 70% for clinician assessment of suboptimal therapy and/or process. CONCLUSION: EMRs can provide moderately reliable identification of patients with suboptimal management of blood pressure in general practice. It should be noted, however, that the complexity of required query formulation is substantial with current tools. Identification of patients with poor persistence of antihypertensive therapy is the most promising outcome for follow-up investigation. The study needs to be replicated in a range of different practice settings.