A peer review programme to audit the management of hypertensive patients in family practices in Israel

We introduced and evaluated a self-audit and peer review programme for the management of hypertension in eight urban and rural family medicine practices in northern Israel between January 1991 and December 1992. Changes in the level of blood pressure control and the effect of peer review and self-audit on physicians’ management of hypertension were evaluated. Participating physicians were provided with feedback throughout the course of the study. Six hundred and seventy-four hypertensive patients from a total adult population of 4445 patients (15%) were identified in eight practices and followed for two years. The percentage of uncontrolled hypertensives (blood pressure ≥ 160/95 mmHg) decreased from 46.8% at the beginning of the study to 34.3% at its conclusion (P = 0.01). Data on prevalence of hypertension were analysed by participating clinics (prevalence range 8.5–24.6%) and by type of community (rural or urban). In rural communities 50% of the hypertensives were 70 years of age, com pared with 39.5% in the urban practices. Differences in prescribing practices among participating physicians were discussed during peer review group meetings and changes in prescribed medications for hypertension were evaluated. We conclude that this method of self-audit and peer review is effective in improving the management of patients with hypertension in family medicine practices. It was implemented at a minimal cost, is feasible in busy practices and can be generalized to the management of other chronic diseases in the community.