Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand

Table 3

Summary of results for the four most common conditions identified in the review

Condition studied	Number of studies	Countries	Criteria	No of studies in which measured	Target standards	Range of results	Source of standards*
Guidelines and RCTs are referenced in the table on the QHC* website.
Asthma	10	UK (9), Australia (1)	Annual review^{40 42–44}	4	100%	Range: 32–82%	British Thoracic Society Guidelines 1993; The National Asthma Campaign Asthma Management Plan 1996
						Median: 63%; Mean: 60%
			Smoking status recorded^{40 42}	2	100%	19% and 80%
			PEFR recorded⁴⁰ ⁴⁴	2	100%	36% and 77%
			Appropriate use of prophylactic treatment⁴⁵^–⁴⁷	3	100% in those patients with at least moderate asthma	Range: 11–73%
						Median 25%; Mean 36%
			Management of acute attacks^{48 49}	2	Nebulised bronchodilators.	32% and 35%
					Systemic steroids	71% and 72%
Cardiovascular disease	17	UK	Prescribing:	13
			Aspirin^{17 18 50–59}	12	100% (if no contraindication)	Range: 49–92%	East London Clinical Guidelines Project 1995 Trials: ISIS-2 1988; Antiplatelets Trialists' Collaboration 1994; Beta-blocker Heart Attack Trial Research Group 1982; Norwegian Multicenter Study Group 1981; SAVE 1992; SOLVD 1991; 4S Study 1994
						Median: 71%; Mean: 72%
			Beta-blockers^{18 51 57}	3	100% with recent AMI, no contraindications	Range: 27–47%
						Median: 32%; Mean: 35%
			ACE inhibitors^{18 25 50 57 60}	5	100% with history of heart failure, no contraindications.	Range: 40–65%
						Median: 48%; Mean: 50%
			Lipid lowering agents^{19 50 51 53}	4	Differing levels of TC requiring treatment (≥5.5 or ≥6.5 mmol/l)	Range: 11–59%
						Median: 19%; Mean: 27%
Diabetes	11	UK (7), NZ (2), Australia (2)	Glycaemic control:				RCGP guidelines 1993; British Diabetic Association Guidelines 1993; RACGP Diabetes Guidelines
			HbA1c/ fructosamine recorded^{40 61–69}	9	100%	Range: 25–100%
						Median: 76%; Mean: 71%
			HbA1c controlled:		100%
			<6 SD above normal population mean⁶¹	1		45% (IDDM),
			<4 SD above normal population mean⁶³ ⁶⁸	2		75% (NIDDM)
			<9.1%⁶⁷	1		46% and 63%
			<7.5%⁶⁹	1		82%
						27%
			Recording of risk factors:		100%
			BP^{40 62–66 69}	7		69–93%
			Wt/BMI^{40 62 63 65 66 69}	6		40–85%
			Smoking^{40 62 63}	3		35–68%
			Lipids/cholesterol^{62–66 69}	6		25–83%
			Renal function⁶²^–⁶⁴	3		45–82%
			Screening:		100%
			Eye examination:
			In previous 12 months⁴⁰ ⁶⁵ ⁶⁹	3		21–37%
			In previous 24 months ^{63 64 66 67 70}	5		44–72%
			Foot examination:
			In previous 12 months⁴⁰ ⁶⁵ ⁶⁶ ⁶⁹	4		3–49%
			In previous 24 months⁶³ ⁶⁴	2		29% and 66%
			Urinalysis
			In previous 12 months⁶⁵ ⁶⁶	2		0.3% and 42%
			In previous 24 months⁶⁴	1		39%
Hypertension	11	UK (10), Australia (1)	Percentage of patients ≥65 years with blood pressure recorded²¹^–²³	3	100%	77–86%	British Hypertension Standards; New Zealand Guideline; WHO guideline; US guideline; Canadian guideline.
			Percentage who had 3 BP recordings taken before initiation of treatment⁷¹ ²³	2	100%	79% and 87%
			Percentage of those with hypertension receiving treatment²¹ ²² ⁷²	11	100%	51–64%
			Percentage with controlled blood pressure			20% (US) to 90% (Canada)
			All guidelines⁷³ ⁷⁴	2	100%	31–83%
			British Hypertension Standards^{21 22 24 41 71–76}	9
			Percentage with sitting and standing BP recorded²²	1	100%	3%

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