Lack of long-term effects from a pedagogical intervention upon blood pressure control--a randomized primary care study.

OBJECTIVE: The primary aim was to evaluate the effect on blood pressure (BP) levels of a previously developed pedagogically structured BP card introduced to patients with inadequately controlled hypertension in primary care. The evaluation was based on the results of a pilot study which is briefly presented. The aim of the study was to validate the positive results from a pilot study in a different, larger setting, for a longer time, and to study the effects of a nurse-led individual health counseling strategy. DESIGN: A "BP card" that summarized the essential targets of hypertension treatment was presented to patients with a small set of questions. An open, randomized, controlled study was performed testing the effect of the BP card: BP card with an added semi-structured nurse counseling versus usual care (3 groups) during 12 months. RESULTS: The effects on BP levels differed greatly from results seen in the pilot study where BP fell significantly in the intervention group as compared with that in the control group. In the main study, however, BP levels declined more than 25/8.5 mmHg in all three groups, with no significant differences between the groups. CONCLUSION: The positive results in the pilot study could not be confirmed in the main study. Furthermore, the nurse-led individual health counseling strategy did not show any additive effects. The reasons for these discrepant findings may be external such as increased awareness of hypertension, and internal factors such as contamination and non-biased recruitment.

Prevalence of pain in general practice.

OBJECTIVE: The aim of this study is to estimate the prevalence and diagnostic pattern of pain at the primary care level during one year in a group practice. This practice serves the patients of a geographically defined area with approximately 14,000 inhabitants. DESIGN: Retrospective analysis of all computerised records of a GP group practice during one year, using a combined computerised search technique and manual check-up. SETTING: Tumba Primary Care District, Stockholm County, Sweden. SUBJECTS: All records of patients who visited Tumba primary care practice during one year. MAIN OUTCOME MEASURES: Pain diagnoses, pain duration, analgesic use, pain category, and referrals. RESULTS: Little less than 30% of the patients, who were treated at a primary care practice, had some kind of medically defined pain problem, requiring the attention of a GP. A little less than half of these patients received a prescription for analgesic drugs. The pain diagnoses at a primary care level showed a predominance of musculoskeletal pain. The patients with pain were much older than population and total practice patients. Among the patients, 37% were in a state of acute pain, 37% suffered from chronic pain, 13% had an intermediate pain duration of 1-3 months, and 11% had a chronic intermittent pain condition (predominantly migraine). CONCLUSIONS: Painful states of the musculoskeletal system constitute more than 2/3 of painful states in primary care. Viewed from a primary care perspective, pain has a great impact on GPs' day-to-day activities and on health economy in general.