Assessment of Factors Influencing Blood Pressure Control in a Managed Care Population

Abstract

We attempted to determine the percentage of patients meeting Health Plan Employer Data Information Set (HEDIS) criteria for blood pressure control (< or = 140/90 mm Hg), to identify factors contributing to differences in blood pressure control among those who met HEDIS criteria and those who did not, and to assess compliance with blood pressure management recommendations established by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) for diabetes mellitus and myocardial infarction. In this retrospective analysis, we randomly selected 502 patient records from three primary care clinics in southeast Michigan. All patients were commercial members of one health maintenance organization, 74% of whom met HEDIS criteria for blood pressure control. These patients took fewer blood pressure drugs throughout the year (p=0.023) and had lower antihypertensive drug costs than those who did not achieve HEDIS blood pressure goals (p=0.016). According to JNC-VI criteria, 46% of diabetic patients were at their blood pressure goal of below 130/85 mm Hg and 71.6% were managed with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Eighty-five percent of patients were taking beta-blockers after myocardial infarction. The percentage of patients achieving target blood pressure exceeded the national average and was associated with few antihypertensive drugs and low drug cost. Effective and appropriate management of blood pressure in people with diabetes remains a challenge.

Blood Pressure Control by Drug Group in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

“…Digit preference may have considerable impact on a performance measure that defines BP control as ≤140/90 mmHg (rather than <140/90)—a definition of BP control which has been used by others, such as HEDIS. 23 In ALLHAT, the overall percent of participants with BP≤140/90 mmHg was 8% greater at year-1 than the percent with BP<140/90 (63% vs 55%); at year-3, it was 8% greater (70% vs. 62%), and at year-5 it was 6% greater (72% vs. 66%). Perhaps because of BP training, these differences are less than what has been reported in a managed care setting (12.7%) 24…”

A influência do plano de saúde na evolução a longo prazo de pacientes com infarto agudo do miocárdio

“…However, this could not be assessed in this study. Interestingly, there are demonstration in the literature that the use of medication with proven efficacy in patients with cardiopathies is low, even in those communities that have free access to such drugs [14][15][16] .…”

Reasons for therapeutic inertia when managing hypertension in clinical practice in non-Western countries

“…24 Depending on the funding model, a specific reimbursement item for the management of hypertension that rewards physicians who apply treatment goals, possibly in conjunction with assisted management by a practice nurse or a pharmacist could result in improved achievements of treatment targets. 26,27 What is known about this topic:…”