An Audit of Use and Monitoring of ACE-inhibitors in General Practice

IntroductionACE-inhibitors are one of the most widely prescribed drugs in general practice for the treatment of hypertension. They are also one of the most frequent drugs associated with preventable drug-related morbidity incidents and guidelines are in place regarding the monitoring of renal function during treatment with these drugs. AimTo assess the pattern of prescribing and monitoring of ACE-inhibitors in a general practice setting. MethodsA retrospective medical records review was undertaken in a general practice in the Kerry region. Data collected included the indication for the ACE-inhibitor and whether blood pressure, electrolytes, renal function and glomerular filtration rate were measured within three months after initiation and in the period from January 2010 to June 2011. Data was entered into Microsoft Excel and analysed using SPSS. ResultsData on 285 patients was analysed and showed that 78.2% of patients were on ACE-inhibitors for treatment of blood pressure. Following initiation of the ACE-inhibitor, 94.8% of patients had their blood pressure checked within 3 months, while 37.1% of patients had electrolytes checked, 51% of patients had their renal function checked and 31% of people had their glomerular filtration rate checked in the same time period. In the months from January 2010 to June 2011, 91.2% of patients had their blood pressure checked with 73% having electrolytes checked, 80.4% having their renal function checked and 54.7% had their glomerular filtration rate checked. Of those who had their renal function checked 26.1% had an abnormal creatinine level. ConclusionFollow up of monitoring blood pressure, renal function, electrolytes and glomerular filtration rate within 3 months initiation of the ACE-inhibitor was poor but annual check up scored highly. Having a recall system in place within the practice for reminding patients to get their blood levels checked may help to increase all percentages to 100%.