The Definition of Maximally Tolerated Blood Pressure Treatment
The Definition of Maximally Tolerated Blood Pressure Treatment
A major issue in the treatment of hypertension in primary care is how a general practitioner decides at what point 'maximally tolerated blood pressure treatment' has been reached. This term was introduced with little guidance in the new General Medical Services contract. In this article, the Primary Care Cardiovascular Society published a consensus statement on this issue and discusses how this definition was reached.
The new General Medical Services contract has introduced the term 'maximally tolerated blood pressure treatment', which it defines as a cut-off point at which a doctor might advise the patient to accept the current blood pressure level. Whilst this is a sensible idea, the contract does not give any guidance as to how the doctor should decide when that point has been reached. In this article the Primary Care Cardiovascular Society considers the issue, looking at available evidence, and publishes a consensus statement on the definition for maximally tolerated blood pressure treatment.
The new General Medical Services contract (nGMS) requires general practitioners (GPs) to achieve various target blood pressures for patients as part of the Quality and Outcomes Framework (QOF) (see table 1 ). In certain patients it is recognised that reaching such targets is not possible because they either do not respond adequately to available treatments or the side effects of such treatments are unacceptably severe. In such cases the contract allows the GP to record that the patient is receiving the Maximally Tolerated Treatment (Code = 8BL0) and to use this as an 'exception report'. This means that the patient will not be counted towards the QOF target percentage. The contract does not define maximally tolerated treatment. The decision as to when this point has been reached is left to the discretion of individual GPs.
Under the new contract, the practice receives payments based on reaching the targets. The validity of any claims will be scrutinised by a panel of QOF assessors made up of independent doctors, nurses and lay people. The GP may be asked to justify a decision to exclude a patient to the QOF assessors. Therefore each practice would be wise to have a written protocol defining maximally tolerated treatment of blood pressure that is based on the evidence available.
A major issue in the treatment of hypertension in primary care is how a general practitioner decides at what point 'maximally tolerated blood pressure treatment' has been reached. This term was introduced with little guidance in the new General Medical Services contract. In this article, the Primary Care Cardiovascular Society published a consensus statement on this issue and discusses how this definition was reached.
The new General Medical Services contract has introduced the term 'maximally tolerated blood pressure treatment', which it defines as a cut-off point at which a doctor might advise the patient to accept the current blood pressure level. Whilst this is a sensible idea, the contract does not give any guidance as to how the doctor should decide when that point has been reached. In this article the Primary Care Cardiovascular Society considers the issue, looking at available evidence, and publishes a consensus statement on the definition for maximally tolerated blood pressure treatment.
The new General Medical Services contract (nGMS) requires general practitioners (GPs) to achieve various target blood pressures for patients as part of the Quality and Outcomes Framework (QOF) (see table 1 ). In certain patients it is recognised that reaching such targets is not possible because they either do not respond adequately to available treatments or the side effects of such treatments are unacceptably severe. In such cases the contract allows the GP to record that the patient is receiving the Maximally Tolerated Treatment (Code = 8BL0) and to use this as an 'exception report'. This means that the patient will not be counted towards the QOF target percentage. The contract does not define maximally tolerated treatment. The decision as to when this point has been reached is left to the discretion of individual GPs.
Under the new contract, the practice receives payments based on reaching the targets. The validity of any claims will be scrutinised by a panel of QOF assessors made up of independent doctors, nurses and lay people. The GP may be asked to justify a decision to exclude a patient to the QOF assessors. Therefore each practice would be wise to have a written protocol defining maximally tolerated treatment of blood pressure that is based on the evidence available.
