Management of Hypertension in Primary Care Safety‐Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices

Fontil, Valy; Bibbins-Domingo, M.A.S. Kirsten; Nguyen, Marielle; Guzman, David; Goldman, Molly

doi:10.1111/1475-6773.12516

Cited by 18 publications

(13 citation statements)

References 37 publications

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“…Compared with free‐equivalent combinations, use of fixed‐dose combination (FDC) therapies in patients who require combination medicines is believed to improve adherence to antihypertensive drugs as it reduces pill burden . However, studies reported that the use of FDCs in patients taking two or more guideline‐recommended antihypertensive medications was relatively low in clinical practices, from 10% to 50% . This meta‐analysis, which includes the latest studies, aimed to systemically evaluate the impact of FDCs on hypertensive medication adherence compared with free‐equivalent combination therapies according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and Meta‐Analysis of Observational Studies in Epidemiology (MOOSE) guidelines …”

Section: Introductionmentioning

confidence: 99%

The impact of fixed‐dose combination versus free‐equivalent combination therapies on adherence for hypertension: a meta‐analysis

Cheng

Zhang

et al. 2018

J of Clinical Hypertension

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Nonadherence to antihypertensive medication is considered as a reason of inadequate control of blood pressure. This meta-analysis aimed to systemically evaluate the impact of fixed-dose combination (FDC) therapy on hypertensive medication adherence compared with free-equivalent combination therapies. Articles were retrieved from MEDLINE and Embase databases using a combination of terms "fixed-dose combinations" and "adherence or compliance or persistence" and "hypertension or antihypertensive" from January 2000 to June 2017 without any language restriction. A meta-analysis was performed to parallel compare the impact of FDC vs free-equivalent combination on medicine adherence or persistence. Studies were independently reviewed by two investigators. Data from eligible studies were extracted and a meta-analysis was performed using R version 3.1.0 software. A total of nine studies scored as six of nine to eight of nine for Newcastle-Ottawa rating with 62 481 patients with hypertension were finally included for analysis. Results showed that the mean difference of medication adherence for FDC vs free-equivalent combination therapies was 14.92% (95% confidence interval, 7.38%-22.46%). Patients in FDC group were more likely to persist with their antihypertensive treatment, with a risk ratio of 1.84 (95% confidence interval, 1.00-3.39). This meta-analysis confirmed that FDC therapy, compared with free-equivalent combinations, was associated with better medication adherence or persistence for patients with hypertension. It can be reasonable for physicians, pharmacists, and policy makers to facilitate the use of FDCs for patients who need to take two or more antihypertensive drugs.

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Section: Introductionmentioning

confidence: 99%

The impact of fixed‐dose combination versus free‐equivalent combination therapies on adherence for hypertension: a meta‐analysis

Cheng

Zhang

et al. 2018

J of Clinical Hypertension

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“…23 Similarly, some evidence suggests that CHCs may be more likely to escalate care for chronic conditions, like uncontrolled hypertension, compared with private practices. 24 During the same time period as our study, there was a concerted national effort to reform healthcare delivery and certify FQHCs as patient-centered medical homes (PCMH). PCMH adoption was, in turn, associated with improvements Fig.…”

Section: Discussionmentioning

confidence: 99%

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

Oronce

Fortuna

2019

J GEN INTERN MED

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BACKGROUND: Community health centers (CHCs) are an integral part of the health care safety net. As health systems seek to improve value, it is important to understand the quality of care provided by CHCs. OBJECTIVE: To evaluate the performance of CHCs compared with private practices on a comprehensive set of high-value and low-value care measures. DESIGN: This cross-sectional study used data from the National Ambulatory Medical Care Survey from 2010 through 2012. We compared CHCs with private practices using logistic regression models that adjusted for age, sex, race/ethnicity, insurance, number of chronic illnesses, rural versus urban location, region of country, and survey year. SETTING/PARTICIPANTS: We included outpatient visits to generalist physicians at either CHCs or private practices by patients 18 years and older. MAIN MEASURES: We examined 12 measures of highvalue care and 7 measures of low-value care. RESULTS: A total of 29,155 physician visits, representing 584,208,173 weighted visits, from 2010 through 2012 were included. CHCs were more likely to provide highvalue care by ordering beta-blockers in CHF (46.9% vs. 36.5%; aOR 2.56; 95%CI 1.18-5.56), statins in diabetes (37.0% vs 35.5%; aOR 1.35; 95%CI 1.02-1.79), and providing treatment for osteoporosis (35.7% vs 23.2%; aOR 1.77; 95%CI 1.05-3.00) compared with private practices. CHCs were more likely to avoid low-value screening EKGs (98.7% vs. 88.0%; aOR 11.03; 95%CI 2.67-45.52), CBCs (75.9% vs. 65.7%; aOR 1.72; 95%CI 1.18-2.53), or urinalyses (86.0% vs. 80.5%; aOR 1.87; 95%CI 1.11-3.14) during a general medical exam. CHCs were also less likely to prescribe antibiotics for a URI (48.3% vs. 63.1%; aOR 0.59; 95%CI 0.40-0.88). CONCLUSIONS: On a number of high-value and lowvalue measures of care, CHCs performed similar to or better than private practices. As healthcare delivery reforms continue to progress, CHCs are well positioned to provide high-value healthcare.

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“…hypertension control may be because HCs with a higher concentration of these patients spent more intensive effort on improving these outcomes, or more diabetes patients sought care from these organizations if they offered diabetes specific services such as lifestyle or exercise classes [40,41]. Among clinical quality measures, few control variables systematically explained urban/rural differences.…”

Section: Plos Onementioning

confidence: 99%

Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

Pourat

Chen

et al. 2020

PLoS ONE

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Background In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. Methods and findings We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. Conclusions Findings highlight HCs’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

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Management of Hypertension in Primary Care Safety‐Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices

Abstract: Increasing physician use of fixed-dose combination drugs may be particularly helpful in improving hypertension control at CHCs where there are higher rates of uncontrolled hypertension.

Cited by 18 publications

References 37 publications

The impact of fixed‐dose combination versus free‐equivalent combination therapies on adherence for hypertension: a meta‐analysis

The impact of fixed‐dose combination versus free‐equivalent combination therapies on adherence for hypertension: a meta‐analysis

Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices

Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

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