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Family physicians and general internists: do they treat hypertensive patients differently?
T E Adamson1, J E Rodnick, D S Guillion
1Department of Medicine, University of California, San Francisco, 94143-0900.
Insights
Family physicians and general internists showed similar approaches to treating hypertension, though internists were more proactive in adjusting medications for uncontrolled blood pressure. Both physician groups face challenges in achieving optimal patient blood pressure control.
Area of Science:
- Internal Medicine
- Family Medicine
- Cardiovascular Health
Background:
- Hypertension management is a critical aspect of primary care.
- Comparing practice patterns between family physicians and general internists can reveal differences in patient care strategies.
- Understanding these differences is essential for improving hypertension treatment outcomes.
Purpose of the Study:
- To compare the treatment approaches of family physicians and general internists for patients with hypertension.
- To identify any significant differences in physician practices, patient characteristics, and treatment outcomes.
- To evaluate the effectiveness of current hypertension management strategies in primary care settings.
Main Methods:
- Retrospective chart review of 2254 hypertensive patients treated by 51 family physicians and 47 general internists in the San Francisco Bay Area.
- Data collected included physician demographics, patient characteristics, medication prescribing patterns, laboratory testing, and patient adherence to treatment.
- Statistical analysis was used to compare the two physician groups on various practice and outcome measures.
Main Results:
- General internists saw fewer patients per hour but were more likely to adjust medications and recall patients with uncontrolled blood pressure.
- Family physicians were more likely to employ registered nurses and delegate patient education to office staff.
- Despite treatment, over 35% of patients in both groups had elevated blood pressure, indicating a need for improved management strategies.
Conclusions:
- While some practice differences exist, family physicians and general internists demonstrate more similarities than differences in managing hypertension.
- Both groups face challenges in achieving optimal blood pressure control, suggesting a need for broader interventions.
- Efforts to improve physician performance in hypertension treatment are warranted and should be applicable to both family physicians and general internists.
Abstract:
This study compared 51 San Francisco Bay Area family physicians and 47 general internists in their treatment of hypertensive patients. Charts from 2254 patients of these physicians were reviewed. The average age and percentage of board certification of both groups of physicians are similar. Patients of general internists were slightly older than the family practice patients (average age 61 vs 59 years). The general internists saw significantly fewer patients per hour (3.0) than the family physicians (3.6). Family physicians were more likely to employ a registered nurse (33%) than were general internists (17%), and family physicians were twice as likely to delegate patient education to office staff than were the general internists. The mean number and kinds of antihypertensive medications prescribed were similar. Internists did more laboratory testing, but the difference was not statistically significant. General internists were more likely to change medication when their patients' blood pressure was uncontrolled than were family physicians (in 60% vs 40% of patients, P = .02), and they were also more likely to recall uncontrolled patients within 3 months than were family physicians (50% vs 35% of patients, P = .05). There was no significant difference in mean diastolic blood pressure or in hypertension-related behaviors, such as medication adherence, aerobic exercise, alcohol consumption, or amount of dietary salt, between the two patient groups; however, over 35% of patients of both groups had elevated blood pressure readings despite taking medications. Overall, there were more similarities than differences in the care physicians provided. Efforts to change physician performance in the treatment of hypertensive patients are still warranted and equally applicable to both groups.
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