Evaluation of Primary Doctor's Knowledge on Target Level of Blood Pressure in Hypertensive Patients

BACKGROUND: The purpose of this study was to find out whether primary physicians know the new guidelines (JNC VII) of target BP (blood pressure) and whether they educate their patients properly or not. METHODS: We made calls to local clinicians (family medicine (FM), internal medicine (IM), oriental medicine (OM)) under the disguise of the patient's caretaker and asked them the target BP for patients with hypertension without any cardiovascular disease and those with hypertension and DM (diabetes mellitus). We categorized the participants according to sex, age and departments. RESULTS: Out of the 145 clinics, 88 clinics responded (28 clinicians of FM, 30 clinicians of IM, 30 clinicians of OM). Questions on systolic target BP for patients with hypertension without cardiovascular disease, 87 clinicians answered. Among them, 64 clinicians (73.6%) answered correctly to the target BP (< or =140 mmHg), in the order of FM, IM, and OM. Questions on the diastolic pressure (< or =90 mmHg), 78 clinicians answered and all of them answered correctly. On the question of the target BP for the patients and hypertension and DM, 55 clinicians (63.2%) answered correctly to the systolic target BP (< or =130 mmHg) in the order of IM, FM, and OM. Only 19 clinicians (32.4%) answered correctly to the diastolic target BP (< or =90 mmHg) in the order of FM, IM, and OM. CONCLUSION: The clinicians have given less correct answers on the target BP in the patients and hypertension and DM than those with only essential hypertension. In conclusion, local clinicians should be fully aware of the target BP in patients with hypertension associated with cardiovascular disease or other complications. Also they should educate their patients properly.

Is Primary Care of Family Medicine better in Quality than that of Other Specialties?

BACKGROUND: The purpose of this study was to assess the quality of primary care by patient-completed questionnaire, and to investigate whether the results of the assessment were different among the specialties of doctors (especially family medicine) and according to the existence of a family doctor. METHODS: The questionnaire, which covers 7 components of primary care (accessibility, continuity, accountability, comprehensiveness, integration, sustained partnership with patients, whole person orientation), was administered to the applicants of health screening center of a university hospital, and factory workers in Cheonan, and residents living in Seoul. Statistic analysis was performed through the collected samples. RESULTS: Total of 574 subjects were analyzed. The mean score (%) of each component of the total sample was as follows; accessibility 45.8, continuity 47.8, comprehensiveness 22.5, accountability 55.5, integration 41.8, sustained partnership with patients 48.9, and whole person orientation 31.8. The mean score (%) of all components were 42.0. Doctors were classified into internists, general surgeons, family physicians, general physicians, and others. Family physicians had the best score in accessibility (P=0.01). The mean score of all components of family physicians was better than that of internists and the other specialties (P<0.05). The respondents who had a family doctor was 129 (22.5%). The mean score of each component was higher than those without a family doctor (P<0.05). CONCLUSION: Family physicians are providing high quality primary care compared to internists and other specialists. Patients who have a family doctor are provided with higher quality primary care than those who do not. Especially, comprehensiveness and whole person orientation need to be improved.