Impact of changes to national guidelines on hypertension-related workload: An interrupted time series analysis in English primary care
Lay-Flurrie SL., Sheppard JP., Stevens RJ., Mallen C., Heneghan C., Richard Hobbs FD., Williams B., Mant J., McManus RJ.
Background In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis. Aim To assess the impact of guideline change on rates of hypertension-related consultation in general practice. Design and setting A retrospective open cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1 April 2006 and 31 March 2017. Method The primary outcome was the rate of face-to-face, telephone, and home visit consultations related to hypertension with a GP or nurse. Age- and sex-standardised rates were analysed using interrupted time-series analysis. Results In 3 937 191 adults (median follow-up 4.2 years) there were 12 253 836 hypertension-related consultations. The rate of hypertension-related consultation was 71.0 per 100 person–years (95% confidence interval [CI] = 67.8 to 74.2) in April 2006, which remained flat before 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend –3.60 per 100 person–years, 95% CI = –5.12 to –2.09). The rate of consultation subsequently decreased to 59.2 per 100 person–years (95% CI = 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis, and persisted when accounting for wider trends in all consultations. Conclusion Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.