Family physicians and general internists: do they treat hypertensive patients differently?

This study compared 51 San Francisco Bay Area family physicians and 47 general internists in their treatment of hypertensive patients. Charts from 2254 patients of these physicians were reviewed. The average age and percentage of board certification of both groups of physicians are similar. Patients of general internists were slightly older than the family practice patients (average age 61 vs 59 years). The general internists saw significantly fewer patients per hour (3.0) than the family physicians (3.6). Family physicians were more likely to employ a registered nurse (33%) than were general internists (17%), and family physicians were twice as likely to delegate patient education to office staff than were the general internists. The mean number and kinds of antihypertensive medications prescribed were similar. Internists did more laboratory testing, but the difference was not statistically significant. General internists were more likely to change medication when their patients' blood pressure was uncontrolled than were family physicians (in 60% vs 40% of patients, P = .02), and they were also more likely to recall uncontrolled patients within 3 months than were family physicians (50% vs 35% of patients, P = .05). There was no significant difference in mean diastolic blood pressure or in hypertension-related behaviors, such as medication adherence, aerobic exercise, alcohol consumption, or amount of dietary salt, between the two patient groups; however, over 35% of patients of both groups had elevated blood pressure readings despite taking medications. Overall, there were more similarities than differences in the care physicians provided. Efforts to change physician performance in the treatment of hypertensive patients are still warranted and equally applicable to both groups.