우리 나라 개원의 고혈압 관리의 질 평가 = Quality Assessment of Hypertension Management of Office-based Physicians in Korea

다국어 초록 (Multilingual Abstract)

Backgroung : Hypertension is one of the most important risk factors the cerebrovascular accident and coronary artery disease which are the major causes of mortality in Korea. In Korea, the quality of care provided by office-based physicians has not been evaluated form ally. The purpose of this study is to assess the quality of hypertension management of office-based physicians.
Method : Self-administerd questionnaires were mailed to the office-based physicians with the speciality of internal medicine, general surgery, family medicine, and general practitioners. Among 2,045 physicians, 981 doctors(48.0%) replied the questionnaires.
Contents of questionnaires were based on the recommendation from the JNC-V report(the Fifth Report of the Joint National Committeeon Detection, Evaluation, and Treatment of High Blood Pressure), and included the criteria of diagnosis, treatment, hollow-up interval, and other characteristics of physicians(age, sex, type of speciality, and location of practice).
Results : Eighty four percent of the office-based physicians made diagnosis of hypertension with less than 3 times of blood pressure measurements. The performance rate of required examination for hypertensives was very low in most items. Rate of fund oscopic examination is the lowest one among them(5.9%). The performance rate of laboratory examination was also low in most items. Internists tended to order more frequent laboratory examination was also low in most items. Internists tended to order more frequent laboratory examinations than any other type of physicians. Only 11.4% of the physicians did appropriate treatment for the mild hypertension case. The antihypertensives selected by the physicians as a first line drug were in the order of beta blocker(26.4%), calcium channel blocker(23.4%), diuretics(23.1%), ACE inhibitors(14.3%). The visit interval for established hypertensives was very short. Proportion of physicians with follow-up interval longer than 4 weeks was only 4.3%.
Conclusions : The overall quality of hypertension management of office-based physicians in Korea in very problematic in many aspects. So further investigations to find out the reasons of low quality and strategy for improving quality of care should be initiated.