P. Krause

High prevalence and poor control of hypertension in primary care: cross-sectional study.

Objective To report: (1) on the background, design and methods of the Hypertension and Diabetes Risk Screening and Awareness (HYDRA) study, (2) on the point prevalence of hypertension in primary care and (3) on the proportion of treated, controlled, and uncontrolled hypertension. Design Cross-sectional point prevalence study. Setting Representative nationwide sample of 1912 primary care practices in Germany. Participants A total of 45 125 unselected primary care attendees. Main outcome measures Prevalence of hypertension based on doctors diagnosis, self-reported diagnosis, and blood pressure (BP) measurements. Results A total of 39% of all patients and 67% of patients aged 60 years or older, respectively, were diagnosed by their doctors as having hypertension. Eighty-four percent of diagnosed patients were on antihypertensive medication, 57% of which were rated by the physician as well controlled. When hypertension was defined as either current BP levels ⩾ 140/90 mmHg and/or current antihypertensive medication, the total point prevalence increased to 50%, while treatment and control rates (BP < 140/90 mmHg) dropped to 64 and 19%, respectively. Conclusions Extrapolation of these findings to the entire primary care patient population seen in the over 20 000 primary care practices in Germany suggests that on an average day, over 700 000 patients with elevated BP are seen by primary care physicians, but that only around 132 000 of these patients are well controlled. Thus, this study not only documents the enormous burden of hypertensive patients in the primary health system, but also highlights the alarming lack of BP control in the vast majority of hypertensive patients.

Leitlinienorientierung deutscher Hausärzte bei der Diagnostik und Therapie der arteriellen Hypertonie und des Diabetes mellitus

SummaryObjectives:The paper examines to what degree German primary care physicians know and work along the rules established in guidelines for arterial hypertension and diabetes mellitus.Methods:HYDRA is a 2-stage cross-sectional point prevalence study with 1912 participating primary care settings throughout Germany including 45125 patients. A pre-study questionnaire to assess doctors practice patterns was used. Subsequently doctors completed a structured clinical appraisal with a diagnostic workup and characterization of the current treatments provided. All patients filled out a questionnaire.Results:Pre-study results show that only every second primary care physician manages the patients according to established guidelines. Further, physicians estimated their own work as problematic and not always successful. Guideline-oriented doctors were more likely to report hypertension and diabetes treatment patterns that also match guideline’s recommendations.Conclusions:The study shows a considerable degree of dissatisfaction with the quality of their work among primary care physicians. Guideline-oriented doctors however reveal more frequently formally adequate management characteristics. This encouraging aspect suggests the need of more successful implementation of medical guidelines in order to achieve improved evidence-based medicine and better patient-oriented health care.

Der Arzneimittelgebrauch und die Compliance von Patienten mit Diabetes mellitus in der Allgemeinarztpraxis nach Arztangaben

ZusammenfassungZiel des Beitrages ist es, selbstreflektierte Einstellungsmuster von Hausärzten zur medikamentösen und nicht-medikamentösen Behandlung von Patienten mit Diabetes mellitus zu analysieren. Ärztliche Aussagen zur Patienten-Compliance werden in die Betrachtungen einbezogen, um Hinweise auf das Medikamenteneinnahmeverhalten der Patienten zu erhalten. HYDRA ist eine Punktprävalenzstudie mit Mehrstufen-und Mehrebenendesign, an der sich 1.912 Allgemeinarztpraxen in Deutschland beteiligten. An zwei Untersuchungshalbtagen wurden Datensätze von 45.125 Patienten erhoben. Als Messinstrumente wurden ein Vorbogen für den Arzt zur Beschreibung der generellen Praxiseigenschaften, ein Patientenfragebogen und ein Arztfragebogen zu den jeweiligen Erkrankungen, der neben patientenspezifischen Daten auch Laborresultate einschloss, eingesetzt. Die Ergebnispräsentation dieses Beitrags stützt sich maßgeblich auf Selbstaussagen der Arzte im Praxiserhebungsbogen. 84% der HYDRA-Studienärzte gaben an, dass ihre Kompetenz im Hinblick auf die medikamentöse Therapie des Diabetes mellitus ausreichend sei. Die von ihnen durchgeführte Arzneimitteltherapie des Diabetes mellitus entspricht gängigen Standards: Sulfonylharnstoffe und Metformin werden am häufigsten eingesetzt, Glitazone und Glinide deutlich seltener verordnet. Auch verschiedene nicht-medikamentöse Behandlungsstrategien wurden als bedeutsam erachtet Die Compliance der Patienten wurde von den HYDRA-Studienärzten in 36% der Fälle als nicht ausreichend eingestuft. Die Patienten mit Diabetes mellitus werden zum überwiegenden Anteil medikamentös behandelt Demgegenüber wird die Versorgungslage im Hinblick auf diätetische Maßnahmen und die Prävention fordernde Beratungsgespräche mit den Patienten als verbesserungsfähig erachtet Entsprechende Maßnahmen könnten die Compliance der Patienten verbessern.AbstractThe aim of the study was to analyse attitudes and patterns of general practitioners in Germany on the treatment of patients with diabetes mellitus as well as to evaluate general practitioner’s statements regarding patient compliance to their treatment. HYDRA is a cross-sectional point prevalence study with 1.912 primary care practices in Germany. Datasets of 45.125 patients were collected. Study instruments included a prestudy questionnaire for physicians to assess general characteristics of the GPs and their practices, a patient questionnaire with particular regard to hypertension and diabetes mellitus. At the same time, physicians described patient’s complaints, severity of the disease and defined further treatment procedures. Finally, laboratory data were also included. The presentation of results is based on self-ratings by physicians in the prestudy questionnaire. 84% of the participating physicians confirmed their own expertise concerning drug therapy of patients with diabetes mellitus. Drugs used were in accordance with the literature: sulfonylureas and metformin were most frequently administered; glitazones and glinides were less frequently given. Dietetic procedures were judged as important by the physicians interviewed. They, furthermore, assumed in 36% of the patients that their compliance was not sufficient According to physicians’ information given in the questionnaire, patients with diabetes mellitus received drugs predominantly. On the other hand the primary care with dietetics and prevention promotion with counselling interviews could well be improved. Corresponding arrangements could enhance the patient’s compliance.

Hypertension and diabetes screening and awareness study (hydra): Prevalence, comorbidity and pharmacological treatment patterns of hypertension and diabetes in primary care in Germany

Clinical Pharmacology & Therapeutics (2003) 73, P69–P69; doi: