Table 2

Examples of differences between the indicators in the US and UK sets

Examples of differences between US and UK indicatorsUS indicator (strength of evidence as assessed by US panel)UK indicatorComment
DiabetesPatients with a diagnosis of diabetes (type 1 or 2) should have glycosylated haemoglobin or fructosamine measured every 6 months (1/3)HbA1c levels should be checked in diabetic patients at least every yearMore frequent monitoring recommended by US panel
DepressionPatients who have suicidality should be admitted if they have psychosis, current drug or alcohol dependency (3)No equivalent indicatorThe second of the US indications is unrealistic in most NHS settings, because of lack of inpatient beds and drug and alcohol treatment facilities. Such patients are often managed in the community.
HeadacheRecurrent moderate or severe tension headache should be treated with a trial of tricyclic antidepressant agents if there is no medical contraindication (1)No equivalent indicatorTricyclics not routlinely used for this purpose in the UK. UK physicians are possibly less interventionalist and may therefore draw different conclusions when there is only limited trial evidence
HypertensionSystolic and diastolic blood pressure should be measured on patients presenting for care at least once each year (3)All adults over 25 should have had their blood pressure measured in the previous 5 yearsMuch more frequent screening recommended by US panel
OsteoarthritisPatients with incident symptoms of hip OA should be offered an A/P film of the affected hip (3)Patients with a new diagnosis of osteoarthritis should not be x -rayed routinelyGreater reliance on radiological investigation by US physicians
Respiratory tract infectionPatients with sore throat and fever, tonsillar exudate and anterior cervical adenopathy should receive immediate treatment for presumed streptococcal infection (2)For patients with sore throat who are systemically unwell and/or have 3 out of 4 Centor criteria, the doctor should discuss the pros and cons of treatmentMore aggressive approach to antibiotic treatment by US physicians.