Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework.
Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework.
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DOI：
10.1136/bmj.a2030
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发表时间：
2008-10-28
影响因子：
105.7
通讯作者：
Morgan, Myfanwy
中科院分区：
文献类型：
--
作者：
Ashworth, Mark;Medina, Jibby;Morgan, Myfanwy
目的 确定初级保健中血压监测和控制的水平，并确定社会剥夺对这些水平的影响。设计回顾性纵向调查，2005 年至 2007 年。制定英格兰的一般做法。参与者数据来自第一年的 8515 个诊所（占所有诊所的 99.3%）、第二年的 8264 个诊所（占所有诊所的 98.3%）和第三年的 8192 个诊所（97.8%）。 主要结果指标 英国质量和结果框架中包含的血压指标和慢性病患病率估计；每种做法的社会剥夺分数、从 2001 年全国人口普查获得的种族数据；一般实践特征。结果 2005年，82.3%的成年人（n=52.8m）有最新的血压记录；到2007年，这一比例已上升至88.3%（n=5320万）。最初，最贫困的五分之一社区的平均血压记录水平与最贫困的五分之一社区的平均血压记录水平之间存在 1.7% 的差距，但三年后，这一差距缩小到 0.2%。 2005 年，最贫困社区实现目标血压水平的范围从糖尿病患者的 71.0%（95% CI 70.4% 至 71.6%）到冠心病患者的 85.1%（84.7% 至 85.6%）；最贫困社区的实践率分别达到 68.9%（68.4% 至 69.5%）和 81.8%（81.3% 至 82.3%）。三年后，最贫困实践的目标实现率分别上升至 78.6%（78.1% 至 79.1%）和 89.4%（89.1% 至 89.7%）。最贫困实践的目标实现率也同样上升，分别达到 79.2%（78.8% 至 79.6%）和 88.4%（88.2% 至 88.7%）。在高血压、脑血管疾病和慢性肾脏疾病中，血压目标的实现也观察到了类似的变化。结论 自 2004 年报告初级保健绩效指标并纳入绩效工资以来，血压监测和控制已得到显着改善。随着成就的提高，最贫困地区和最贫困地区之间的成就差距几乎消失。
Objective To determine levels of blood pressure monitoring and control in primary care and to determine the effect of social deprivation on these levels. Design Retrospective longitudinal survey, 2005 to 2007. Setting General practices in England. Participants Data obtained from 8515 practices (99.3% of all practices) in year 1, 8264 (98.3%) in year 2, and 8192 (97.8%) in year 3. Main outcome measures Blood pressure indicators and chronic disease prevalence estimates contained within the UK quality and outcomes framework; social deprivation scores for each practice, ethnicity data obtained from the 2001 national census; general practice characteristics. Results In 2005, 82.3% of adults (n=52.8m) had an up to date blood pressure recording; by 2007, this proportion had risen to 88.3% (n=53.2m). Initially, there was a 1.7% gap between mean blood pressure recording levels in practices located in the least deprived fifth of communities compared with the most deprived fifth, but, three years later, this gap had narrowed to 0.2%. Achievement of target blood pressure levels in 2005 for practices located in the least deprived communities ranged from 71.0% (95% CI 70.4% to 71.6%) for diabetes to 85.1% (84.7% to 85.6%) for coronary heart disease; practices in the most deprived communities achieved 68.9% (68.4% to 69.5%) and 81.8 % (81.3% to 82.3%) respectively. Three years later, target achievement in the least deprived practices had risen to 78.6% (78.1% to 79.1%) and 89.4% (89.1% to 89.7%) respectively. Target achievement in the most deprived practices rose similarly, to 79.2% (78.8% to 79.6%) and 88.4% (88.2% to 88.7%) respectively. Similar changes were observed for the achievement of blood pressure targets in hypertension, cerebrovascular disease, and chronic kidney disease. Conclusions Since the reporting of performance indicators for primary care and the incorporation of pay for performance in 2004, blood pressure monitoring and control have improved substantially. Improvements in achievement have been accompanied by the near disappearance of the achievement gap between least and most deprived areas.
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