Twenty five years of case finding and audit in a socially deprived community.

Hart, Jonathan; Thomas, Carol; Gibbons, Brian; Edwards, C.; Hart, Mary M.; Jones, Janet; Jones, Michael Owen; Walton, Pam

doi:10.1136/bmj.302.6791.1509

Cited by 75 publications

(46 citation statements)

References 29 publications

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“…The medical profession has failed to develop an effective strategy to improve detection and treatment of hypertension at a community level, although individual practitioners have demonstrated that improved detection and control of hypertension can be achieved even in socially deprived communities [21]. A failure of current guidelines to address prescribers' concerns and a lack of involvement of target clinicians in the development of guidelines could be factors responsible for this problem [22].…”

Section: Discussionmentioning

confidence: 99%

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford

Asghar

1995

Brit J Clinical Pharma

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1 The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2 Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3 Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4 Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. These results suggest that effective interventions in addition to guidelines need to be developed if hypertension in the elderly is to be consistently managed.

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Section: Discussionmentioning

confidence: 99%

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Ford

Asghar

1995

Brit J Clinical Pharma

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“…There was also a 28% reduction in coronary heart disease (CHD)-related mortality over a 25-year period in his practice, compared with a similar, neighbouring practice, although he and his team were careful not to attribute this reduction in mortality solely to their approach of case finding and audit. 16,17 Integral to success was seeing patients as 'co-producers' of their health and it is this, coupled with a practitioner's knowledge of their patients' health, personal and social situations, that, for some, remain central to the approach of anticipatory care. [18][19][20] In a fragmented healthcare system, this approach may be difficult to replicate.…”

Section: Resultsmentioning

confidence: 99%

Delivering a national programme of anticipatory care in primary care: a qualitative study

O’Donnell

Mackenzie²,

Reid³

et al. 2012

Br J Gen Pract

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BackgroundPrimary prevention often occurs against a background of inequalities in health and health care. Addressing this requires practitioners and systems to acknowledge the contribution of health-related and social determinants and to deal with the lack of interconnectedness between health and social service providers. Recognising this, the Scottish Government has implemented a national programme of anticipatory care targeting individuals aged 45-64 years living in areas of socioeconomic deprivation and at high risk of cardiovascular disease. This programme is called Keep Well. AimTo explore the issues and tensions underpinning the implementation of a national programme of anticipatory care. Design and settingA qualitative study in five Wave 1 Keep Well pilot sites, located in urban areas of Scotland, and involving 79 general practices. MethodAnnual semi-structured interviews were conducted with 74 key stakeholders operating at national government level, local pilot level and within general practices, resulting in 118 interviews. Interview transcripts were analysed using the framework approach. ResultsFour underlying tensions were identified. First, those between a patient-focused generalpractice approach versus a population-level health-improvement approach, linking disparate health and social services; secondly, medical approaches versus wider social approaches; thirdly, a population-wide approach versus individual targeting; and finally, reactive versus anticipatory care. ConclusionImplementing an anticipatory care programme to address inequalities in cardiovascular disease identified several tensions, which need to be understood and resolved in order to inform the development of such approaches in general practice and to develop systems that reduce the degree of fragmentation across health and social services. Keywordsanticipatory care; cardiovascular diseases; inequalities, health; primary prevention. decisionmaking.

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“…3 The challenge is not only to ascertain risks, but also to follow this up, working with patients (in Tudor Hart's phrase 'initially face to face, eventually side by side'), flexibly but consistently, as needs determine, over the long term. By the sum of such relationships, the NHS can improve health and narrow inequalities.…”

Section: Seriesmentioning

confidence: 99%

Anticipatory care in very deprived areas

Watt¹

2011

Br J Gen Pract

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Twenty five years of case finding and audit in a socially deprived community.

Abstract: Objective-To evaluate audit and case finding (whole population care) in a community over 25 years.Design

Cited by 75 publications

References 29 publications

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Management of hypertension in the elderly: attitudes of general practitioners and hospital physicians.

Delivering a national programme of anticipatory care in primary care: a qualitative study

Anticipatory care in very deprived areas

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