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 review40 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 recorded40 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 attacks48 49 | 2 | Nebulised bronchodilators. | 32% and 35% | ||||
Systemic steroids | 71% and 72% | ||||||
Cardiovascular disease | 17 | UK | Prescribing: | 13 | |||
Aspirin17 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-blockers18 51 57 | 3 | 100% with recent AMI, no contraindications | Range: 27–47% | ||||
Median: 32%; Mean: 35% | |||||||
ACE inhibitors18 25 50 57 60 | 5 | 100% with history of heart failure, no contraindications. | Range: 40–65% | ||||
Median: 48%; Mean: 50% | |||||||
Lipid lowering agents19 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 recorded40 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% | ||||||
BP40 62–66 69 | 7 | 69–93% | |||||
Wt/BMI40 62 63 65 66 69 | 6 | 40–85% | |||||
Smoking40 62 63 | 3 | 35–68% | |||||
Lipids/cholesterol62–66 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 Standards21 22 24 41 71–76 | 9 | ||||||
Percentage with sitting and standing BP recorded22 | 1 | 100% | 3% |