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26 Médecine à l’acte/médecine au forfait – ANNEXES KCE Reports 85 S % of population whose BP recorded in past 5 years (14,15) % of those with diagnosis of IHD whose BP recorded in past year (14,15) % of those with diagnosis of ischaemic stroke or TIA whose BP recorded in past year (14,15) % with elevated BP ( > 160/90) (14) The diagnosis of HT should be clearly identifiable on the electronic or paper records of all known hypertensives. (2,3) Practice maintains a register of hypertension patients (10) Practice as a register of the age-sex distribution of the practice population (10) Effective hypertension management – annual calibration of sphyngmomanometers (10) Record of follow-up for borderline or elevated BP measurements with repeated measures. (1) Patients prescribed antihypertensive medication should have their blood pressure recorded al least once per year. (2,3) Record of BP measurement in hypertensive patients at least once every 6 months. (1) Patients with a blood pressure > 160/100 should have their blood pressure remeasured within 3 months. (2,3) ″remeasurement of BP for those with high BP” = number with BP re-measured within 3 month / patients with a BP >= 160/100 (5) % of population identified as hypertensive whose BP recorded in the past year (14,15) Record of weight measurement in hypertensive patients at least once yearly. (1) Initial history should document assessment of the following within three months of diagnosis : Personal history of peripheral vascular disease, diabetes, hyperlipidaemia, smoking status, alcohol consumption. (2,3) Blood pressure should be measured on at least 3 separate days before starting drug treatment unless blood pressure > 190/140 (2) Blood pressure should be measured on at least 3 separate days before starting drug treatment unless blood pressure > 200/110 (3) Percentage who had 3 BP recordings taken before initiation of treatment (target standards = 100%) (7) Drug therapies should be offered in all patients with sustained (on more than 3 occasions) systolic BP >= 160 mm Hg or sustained diastolic BP >= 100 mm Hg despite up to six months of non-pharmaceutical measures, unless contraindicated or intolerant (2,3) Actively treat hypertensive patients with persistent blood pressure level of 160/100 mmHg or more pharmacologically. (1) Patients with sustained high readings (> 150/90 on 3 or more occasions) who are already taking anti-hypertensive should be offered a change in therapy. (2,3) Drug treatment is offered in patients with sustained (on more than 3 occasions) systolic BPs of 140-159 mmHg or diastolic BPs 90-99 mm Hg if despite 6 months of non-pharmacological measures : - target organ damage is present (defined as an abnormal result on any of the tests/exams that pass) - there is
KCE Reports 85 S Médecine à l’acte/médecine au forfait – ANNEXES 27 evidence of established cardio-vascular disease - the patient is diabetic - the 10-year CHD risk is >= 30% , ( (3): 10-year CHD risk is >=15%) (2,3) Percentage of those with hypertension receiving treatment (target standards = 100%) (7) All patients with a diagnosis of hypertension should have the following nonpharmacological measures recommended: Weight reduction if BMI > 30, limitation of alcohol consumption. (2,3) % of population identified as hypertensive whose most recent diastolic BP < 90 mm Hg (14,15) % of population identified as Hypertensive whose most recent systolic BP < 160 mm Hg (14,15) Percentage with controlled blood pressure : - all guidelines - British Hypertension Standards (target standards = 100 %) (7). Diabetic patients with a BP> 140/85 mmHg should have their blood pressure remeasured within 3 months. (2,3) If a diabetic has a sustained BP recorded as > 140/85 mmHg on 3 or more consecutive occasions then a change in non-drug or drug management should be offered. (2,3) indicateurs concernant les medicaments: decision de se limiter aux indicateurs du feedback, pour lesquels il y a déjà consensus en Belgique. Enalapril first line – Captopril (8) Drugs of limited clinical value : diuretic-potassium combinations ( ≤ 0,6items/100PU/yr.) (8) Percentage of bendrofluazide 5 mg tablets to all bendrofluazide items in the past year : lower is better (18) Ratio of bendrofluazide 2.5 mg items to all bendrofluazide items (17) Drug choice within a therapeutic group (as % of relevant BNF section): furosemide and bendrofluazide (55%) (8) Drug choice within a therapeutic group (as % of relevant BNF section): atenolol and propanolol (75%) (8) High rate of prescribing atenolol as a percentage of all beta-blockers (19) Ratio of compound diuretics items to all diuretic items (17) Patients with the conditions below should not be treated with the following drugs : beta-blockers for patients with a history of asthma; ACE inhibitors for pregnants women. (2,3) % of (compound diuretics + diuretics with potassium) to all diuretic items in the past year : lower is better (18) Indicateurs du feedback, mais concernant surtout les coûts: DDD/patient pour chaque antihypertenseur. Indice et percentile; DDD totaux, coût total et coût/DDD pour chaque. (25) ASTHME ET BPCO Dans l’étude de Veninga (34), pour identifier les patients asthmatiques, les auteurs prennent comme critère d’inclusion les patients recevant au moins une médication anti-asthmatique (code ATC : R03) , en inhalation ou par voie orale. De plus, les données ont été restreintes
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KCE reports 1. Efficacité et renta
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74. Oxygénothérapie Hyperbare: Ra
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