Abstract

The North Hammersmith stroke prevention project was designed to reduce the number of deaths from stroke in this health district by improving the detection of hypertensive patients and thereafter reducing the default rate from treatment. Starting in May 1979 general practitioners in the district were asked to register hypertensive patients over the age of 40 so that the proportion of such patients in each practice was known and could be compared with the average for all practices. This confidential information was fed back every year to the individual general practitioners so that they could assess their performance. Forty of 44 eligible general practitioners agreed to participate and 29 proceeded to register patients. Over a three year period 1006 patients were registered, representing 4.3% of the project population over the age of 40. Individual practice registration rates ranged from 1.1% to 9.1%. Sixty five per cent of the registered patients were women, 34% of all registrations were in the age group 60-69, 31% in the group 50-59, 12% in the group 40-49, and 23% in the group over 70. The average blood pressure before treatment was 190/111 mm Hg. After one and two years the patients were contacted or their notes examined to ensure that they still receiving treatment. Persistant default from treatment occurred in under 12% over the three year period.