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Hypertension Medication Access and Self-Management Among the Elderly by Education: Insights from the 2013 USA Medicare Current Beneficiary’s Survey
A624
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
1Yonsei
University Health System, Seoul, Korea, Republic of (South), 2Korea University Guro Hospital, Seoul, Korea, Republic of (South), 3Samsung Medical Center, Seoul, Korea, Republic of (South), 4Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea, Republic of (South)
Objectives: Even though PAD is known to have significant effect on QoL, due to its asymptomatic nature, it is often underdiagnosed and undertreated. Therefore, in this study, we investigated factors associated with patients’ change of QoL(Δ QoL) in Korea. Methods: Data in this analysis was from PAD OR, which was a prospective, observational study conducted from June 2013~August 2014 in 23 participating tertiary-hospitals. Patients with age≥ 20years, ankle-brachial index(ABI)≤ 0.9, and lower-extremity artery stenosis≥ 50% on CT-angiography or peak-systolic-velocityratio(PSVR)≥ 2.0 on duplex sonography were included. Clinical characteristics were collected through medical chart review, and QoL was assessed via patient survey using EQ-5D and EQ-VAS measures. Data were collected at the time of study enrollment and at 6-month follow-up(FU). Multiple linear regression analysis was conducted to assess factors associated with Δ QoL after 6-month. Results: Total of 1,260 patients(mean age 69.76±9.94, male 77.0%) were included in the analysis. Patients’ mean EQ-5D index scores significantly increased by 0.04±0.20(p< 0.0001) after 6 months(baseline;0.64±0.24, 6-month FU;0.68±0.20). As a result of multivariable analysis, factors associated with Δ QoL was change of Fontaine stage where ‘Improvement of Fontaine stage’ compared to ‘No change’(B= 0.06646, p< 0.0001) had positive effect on Δ QoL and ‘Deterioration of Fontaine stage’ compared to ‘No change’(B= -0.03902, p= 0.0246) had negative effect on Δ QoL. Underlying conditions such as diabetes(B= 0.02299, p= 0.0469) had a positive effect, while cardiovascular comorbidities(B= -0.03132, p= 0.0101) had a negative effect. Others such as treatment with pharmacotherapy(B= 0.05257, p= 0.0356) and patients’ smoking status of no smoking for the past 6 months compared to current smoking(B= -0.03254, p= 0.0399), had a positive effect on Δ QoL. Conclusions: Since PAD is often diagnosed after symptom deterioration, patients’ QoL is more likely to be have been impacted even before the disease diagnosis. Therefore, more attention to the disease for earlier diagnosis and provision of timely pharmacotherapy is critical in management of patients’ QoL. PCV129 Comparing Quality of Life of (RT-PA) with No-(RT-PA) in Stroke Attacked Patients Goudarzi Z1, najaf Pur Shehni J1, borhan Haghighi A2, Farhoudi M3, Hatam N4 1Tehran University of Medical Science, tehran, Iran (Islamic Republic of), 2Shiraz Medical School, shiraz, Iran (Islamic Republic of), 3Tabriz University of Medical Science, tabriz, Iran (Islamic Republic of), 4School of Management and Information Sciences, shiraz, Iran (Islamic Republic of)
Objectives: Stroke has been considered as one of the most common neurological disease life-threatening and a global health problem. It causes disability in adults and ranked as the third leading causes of human mortality worldwide. The aim of this study was to compare the quality of life in Stroke’s patients in both treated and not treated groups with (rt-PA). Methods: We conducted a cohort study on 126 stroke attacked patients, 42 and 84 patients treated and not treated with (rt-PA) respectively. We used a disease specific questionnaire for stroke (SSQOL) and generic questionnaire (EQ5D) . The patients were studied from the first week of treatment and continued up to 3 months after completion of the therapy (treatment with and without rt-PA), followed up and then complete the questionnaires. Both groups were tested for significant differences regarding socio-demographic. A multiple linear regression model was implemented to find out the factors affecting different aspect of QOL among the patients. Results: stroke attacked group was differ in physical and mental health, composite scores as well as relative scales. There was a significant difference between the MRS and NIHSS scores in the two groups Stroke’s patients treated and not treated with (rt-PA) after 3 months(p < 0.05). Quality of life in patients treated with (rt-PA) was ./67 and in patients treated with No-(rt-PA) was ./07. Conclusions: By this study, we can conclude that a significant differences between QOL of patients were occurred when treated with (rt-PA) in compare with not treated with (rt-PA). In over all we can say (rt-PA) improved the quality of life in stroke attacked patients significantly. This study suggests that (rt-PA) improved the quality of life in stroke attacked patients by improving the sleep patterns, physical, social and psychological conditions.
CARDIOVASCULAR DISORDERS – Health Care Use & Policy Studies PCV130 Hypertension Medication Access and Self-Management Among the Elderly by Education: Insights from the 2013 USA Medicare Current Beneficiary’s Survey Sentell T1, Shen C2, Landsittel D2, Taira D3 1University of Hawaii, Honolulu, HI, USA, 2University of Pittsburgh, Pittsburgh, PA, USA, 3University of Hawaii at Hilo, Honolulu, HI, USA
Objectives: Hypertension, a major risk-factor for cardiovascular disease and stroke, is a global public health problem. Effective antihypertensive medication use can decrease morbidity/mortality, yet medication access may vary by factors beyond insurance coverage. We measured educational disparities in hypertension medication access and confidence in hypertension self-management among the elderly with Medicare coverage in the USA. Methods: The sample included those age 65 years or older with hypertension in the 2013 Medicare Current Beneficiary Survey (n= 6652). We examined satisfaction with access to hypertension medications and confidence in hypertension self-management by education: less than high school, high school graduate, and some college or more (comparison group). Multivariable logistic regression was used to model the outcomes of being very satisfied, or very confident, controlling for age group, gender, income, race/ethnicity, comorbidity, health status, and type of prescription drug coverage (Medicare Part D, private, Medicare Advantage, Medicaid dual eligible, none). Significance was set at p< .05. Results: For education, 21.1% had less than high school, 35.9% were high school graduates, and 43.0% had at least some college. In multivariable
models, having less than a high school education was negatively associated with satisfaction in: the amount paid for medication (OR:0.68; 95%CI:0.56-0.83), the list of drugs covered (OR:0.69; 95%CI:0.56-0.85), and finding a pharmacy that accepted their drug plan (OR:0.58; 95%CI:0.47-0.72), compared to those with some college education. Both those with less than a high school education (OR:0.64; 95%CI: 0.530.77) and with a high school degree (OR:0.70; 95%CI:0.62-0.80) were significantly less confident in managing their hypertension than those with some college education. Conclusions: This nationally representative sample revealed gaps in access to prescription medications by educational attainment, as well as less confidence in self-management, even after controlling for prescription drug coverage and other sociodemographic factors. Those with low education may lack drug coverage and/ or chronic care managment plans that meet their needs. PCV131 Pharmacological Adherence to Clinical Guidelines in Acute Coronary Syndrome in Hospitals Jabbari A1, Sadeghi M2, Reisi A3, Asgaridastjerdi H3, Khorasani E4 1Health Management and economics Research Centre, Isfahan University of Medical Science, Isfahan, Iran (Islamic Republic of), 2Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 3Isfahan University of Medical Science, Isfahan, Iran (Islamic Republic of), 4Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)
Objectives: Pharmacological adherence is critical by cardiologists in Acute Coronary Syndrome. In this study the extent of pharmacological adherence by cardiologists from updated clinical guidelines were conducted in cardiac patients on admission and at discharge in 4 hospitals in Isfahan, Iran. Methods: A retrospective cross sectional study was conducted on medical records of Acute Coronary Syndrome (unstable angina and myocardial infarction). A range of clinical data including prescribed medications on admission and at discharge, disease background, laboratory tests and biomarkers were extracted from patients’ medical records. The researcher’s focus was more on prescription of recommended medications from clinical guidelines utilizing aspirin ± clopidogrel, beta blockers, statins, ACEI (angiotensin- converting enzyme inhibitor) or ARB (angiotensin II receptor blockers). Patients regarding cardiologist’s pharmacological adherence were divided into two groups of good-adherence equals or above %75 (4/3, 4/4) and poor-adherence below %75 (1/4, 2/4). Results: A total of 200 medical records of ACS patients was extracted and reviewed. %67 of population was male and 33% was female; %19.5 was young (equal and below 50 years old) and %80.5 was old (above 50 years old). Patients with ST segment elevation myocardial infarction accounted for %18.5 whereas the ones with non ST segment elevation myocardial infarction were %23. On admission and at discharge %99, %80, %58 and %96.5 of patients received antiplatelet, beta blockers, ACEI/ARB and statins respectively. In general the extent of adherence to updated clinical guidelines on admission was 58.5 and at discharge 53.9 which was poor. Conclusions: Poor adherence to updated clinical guidelines by cardiologists due to secondary prevention of Acute Coronary Syndrome (ACS) is very worrisome. It is necessary to investigate the reasons of non-adherence regarding aging society and the prevalence of cardiac disease. PCV132 Penetration of Peripheral Vascular Interventions in Hungary Endrei D, Horváth L, Boncz I University of Pécs, Pécs, Hungary
Objectives: Our investigation aimed to analyse the penetration of peripheral vascular interventions among Hungarian hospitals, with special respect to the Clinical Center of the University of Pécs, a tertiary level university teaching hospital. Methods: Data analysed were taken from the database of the Hungarian National Health Insurance Fund Administration, covering the year 2015. We identified the patients with the Hungarian Diagnosis Related Groups (DRG) categories. We investigated the following DRG groups: 190 C, 190 D, 190 E, 190 F, 190 G, 190 H. Hospitals that had reported patients with these DRG codes were involved into the study. Our investigation focused on case numbers and percentage ratio. Results: The general market share of the Clinical Center of the University of Pécs (CC-UP) was 5.0 % from all the active inpatient care services in 2015. Institutions performing 190C Percutaneous and other vascular surgeries (with the implantation of one or more stents or homograft) reported a total 1111 cases, out of which 135 (12%, which is the second largest market share: 2nd place) was reported by the CC-UP. Institutions performing 190D Percutaneous and other vascular surgeries without stent implantation reported a total 592 cases, according to reported performance, the CC-UP had 229 cases (38.7%, 1st place). Regarding 190E Percutaneous vascular surgeries with further treatment (with one or more stents) the reported number was a total of 1288 cases, out of which the CC-UP carried out 7 (0.5%, 28th place). The total number of 190F Percutaneous vascular surgeries without further treatment including stent implantation amounted to 822, and the CC-UP had 29 cases (3.5 %, 9th place). Conclusions: The case numbers and percentage ratio of peripheral vascular interventions performed at hospitals showed considerable differences, even in a tertiary level teaching hospital. Penetration rate of peripheral vascular interventions should be increased in Hungary. PCV133 Intermediate Evaluation of Vivoptim: The Mgen (French Insurer) Prevention Program for Cardiovascular Risks Blachier M1, Vimont A1, Ballouk S2, Le Lann A2, Femery V2 1PUBLIC HEALTH EXPERTISE, Paris, France, 2MGEN, Paris, France
Objectives: VIVOPTIM is an innovative prevention program for cardiovascular (CV) risks designed and financed by the French insurer MGEN Union. It is a personalized program based on digital services, telemedicine devices and direct coaching. A pilot program was launched in 2015 in two French regions (Midi Pyrénées and Bourgogne). A total of 15 different prevention programs were proposed: obesity, atherosclerosis, hypertension, physical activity… based on their CV risk profile. An evaluation of VIVOPTIM after 10 months of follow up was conducted. Methods:
VA L U E I N H E A LT H 2 0 ( 2 0 1 7 ) A 3 9 9 – A 8 1 1
1Yonsei
University Health System, Seoul, Korea, Republic of (South), 2Korea University Guro Hospital, Seoul, Korea, Republic of (South), 3Samsung Medical Center, Seoul, Korea, Republic of (South), 4Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea, Republic of (South)
Objectives: Even though PAD is known to have significant effect on QoL, due to its asymptomatic nature, it is often underdiagnosed and undertreated. Therefore, in this study, we investigated factors associated with patients’ change of QoL(Δ QoL) in Korea. Methods: Data in this analysis was from PAD OR, which was a prospective, observational study conducted from June 2013~August 2014 in 23 participating tertiary-hospitals. Patients with age≥ 20years, ankle-brachial index(ABI)≤ 0.9, and lower-extremity artery stenosis≥ 50% on CT-angiography or peak-systolic-velocityratio(PSVR)≥ 2.0 on duplex sonography were included. Clinical characteristics were collected through medical chart review, and QoL was assessed via patient survey using EQ-5D and EQ-VAS measures. Data were collected at the time of study enrollment and at 6-month follow-up(FU). Multiple linear regression analysis was conducted to assess factors associated with Δ QoL after 6-month. Results: Total of 1,260 patients(mean age 69.76±9.94, male 77.0%) were included in the analysis. Patients’ mean EQ-5D index scores significantly increased by 0.04±0.20(p< 0.0001) after 6 months(baseline;0.64±0.24, 6-month FU;0.68±0.20). As a result of multivariable analysis, factors associated with Δ QoL was change of Fontaine stage where ‘Improvement of Fontaine stage’ compared to ‘No change’(B= 0.06646, p< 0.0001) had positive effect on Δ QoL and ‘Deterioration of Fontaine stage’ compared to ‘No change’(B= -0.03902, p= 0.0246) had negative effect on Δ QoL. Underlying conditions such as diabetes(B= 0.02299, p= 0.0469) had a positive effect, while cardiovascular comorbidities(B= -0.03132, p= 0.0101) had a negative effect. Others such as treatment with pharmacotherapy(B= 0.05257, p= 0.0356) and patients’ smoking status of no smoking for the past 6 months compared to current smoking(B= -0.03254, p= 0.0399), had a positive effect on Δ QoL. Conclusions: Since PAD is often diagnosed after symptom deterioration, patients’ QoL is more likely to be have been impacted even before the disease diagnosis. Therefore, more attention to the disease for earlier diagnosis and provision of timely pharmacotherapy is critical in management of patients’ QoL. PCV129 Comparing Quality of Life of (RT-PA) with No-(RT-PA) in Stroke Attacked Patients Goudarzi Z1, najaf Pur Shehni J1, borhan Haghighi A2, Farhoudi M3, Hatam N4 1Tehran University of Medical Science, tehran, Iran (Islamic Republic of), 2Shiraz Medical School, shiraz, Iran (Islamic Republic of), 3Tabriz University of Medical Science, tabriz, Iran (Islamic Republic of), 4School of Management and Information Sciences, shiraz, Iran (Islamic Republic of)
Objectives: Stroke has been considered as one of the most common neurological disease life-threatening and a global health problem. It causes disability in adults and ranked as the third leading causes of human mortality worldwide. The aim of this study was to compare the quality of life in Stroke’s patients in both treated and not treated groups with (rt-PA). Methods: We conducted a cohort study on 126 stroke attacked patients, 42 and 84 patients treated and not treated with (rt-PA) respectively. We used a disease specific questionnaire for stroke (SSQOL) and generic questionnaire (EQ5D) . The patients were studied from the first week of treatment and continued up to 3 months after completion of the therapy (treatment with and without rt-PA), followed up and then complete the questionnaires. Both groups were tested for significant differences regarding socio-demographic. A multiple linear regression model was implemented to find out the factors affecting different aspect of QOL among the patients. Results: stroke attacked group was differ in physical and mental health, composite scores as well as relative scales. There was a significant difference between the MRS and NIHSS scores in the two groups Stroke’s patients treated and not treated with (rt-PA) after 3 months(p < 0.05). Quality of life in patients treated with (rt-PA) was ./67 and in patients treated with No-(rt-PA) was ./07. Conclusions: By this study, we can conclude that a significant differences between QOL of patients were occurred when treated with (rt-PA) in compare with not treated with (rt-PA). In over all we can say (rt-PA) improved the quality of life in stroke attacked patients significantly. This study suggests that (rt-PA) improved the quality of life in stroke attacked patients by improving the sleep patterns, physical, social and psychological conditions.
CARDIOVASCULAR DISORDERS – Health Care Use & Policy Studies PCV130 Hypertension Medication Access and Self-Management Among the Elderly by Education: Insights from the 2013 USA Medicare Current Beneficiary’s Survey Sentell T1, Shen C2, Landsittel D2, Taira D3 1University of Hawaii, Honolulu, HI, USA, 2University of Pittsburgh, Pittsburgh, PA, USA, 3University of Hawaii at Hilo, Honolulu, HI, USA
Objectives: Hypertension, a major risk-factor for cardiovascular disease and stroke, is a global public health problem. Effective antihypertensive medication use can decrease morbidity/mortality, yet medication access may vary by factors beyond insurance coverage. We measured educational disparities in hypertension medication access and confidence in hypertension self-management among the elderly with Medicare coverage in the USA. Methods: The sample included those age 65 years or older with hypertension in the 2013 Medicare Current Beneficiary Survey (n= 6652). We examined satisfaction with access to hypertension medications and confidence in hypertension self-management by education: less than high school, high school graduate, and some college or more (comparison group). Multivariable logistic regression was used to model the outcomes of being very satisfied, or very confident, controlling for age group, gender, income, race/ethnicity, comorbidity, health status, and type of prescription drug coverage (Medicare Part D, private, Medicare Advantage, Medicaid dual eligible, none). Significance was set at p< .05. Results: For education, 21.1% had less than high school, 35.9% were high school graduates, and 43.0% had at least some college. In multivariable
models, having less than a high school education was negatively associated with satisfaction in: the amount paid for medication (OR:0.68; 95%CI:0.56-0.83), the list of drugs covered (OR:0.69; 95%CI:0.56-0.85), and finding a pharmacy that accepted their drug plan (OR:0.58; 95%CI:0.47-0.72), compared to those with some college education. Both those with less than a high school education (OR:0.64; 95%CI: 0.530.77) and with a high school degree (OR:0.70; 95%CI:0.62-0.80) were significantly less confident in managing their hypertension than those with some college education. Conclusions: This nationally representative sample revealed gaps in access to prescription medications by educational attainment, as well as less confidence in self-management, even after controlling for prescription drug coverage and other sociodemographic factors. Those with low education may lack drug coverage and/ or chronic care managment plans that meet their needs. PCV131 Pharmacological Adherence to Clinical Guidelines in Acute Coronary Syndrome in Hospitals Jabbari A1, Sadeghi M2, Reisi A3, Asgaridastjerdi H3, Khorasani E4 1Health Management and economics Research Centre, Isfahan University of Medical Science, Isfahan, Iran (Islamic Republic of), 2Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of), 3Isfahan University of Medical Science, Isfahan, Iran (Islamic Republic of), 4Tehran University of Medical Sciences, Tehran, Iran (Islamic Republic of)
Objectives: Pharmacological adherence is critical by cardiologists in Acute Coronary Syndrome. In this study the extent of pharmacological adherence by cardiologists from updated clinical guidelines were conducted in cardiac patients on admission and at discharge in 4 hospitals in Isfahan, Iran. Methods: A retrospective cross sectional study was conducted on medical records of Acute Coronary Syndrome (unstable angina and myocardial infarction). A range of clinical data including prescribed medications on admission and at discharge, disease background, laboratory tests and biomarkers were extracted from patients’ medical records. The researcher’s focus was more on prescription of recommended medications from clinical guidelines utilizing aspirin ± clopidogrel, beta blockers, statins, ACEI (angiotensin- converting enzyme inhibitor) or ARB (angiotensin II receptor blockers). Patients regarding cardiologist’s pharmacological adherence were divided into two groups of good-adherence equals or above %75 (4/3, 4/4) and poor-adherence below %75 (1/4, 2/4). Results: A total of 200 medical records of ACS patients was extracted and reviewed. %67 of population was male and 33% was female; %19.5 was young (equal and below 50 years old) and %80.5 was old (above 50 years old). Patients with ST segment elevation myocardial infarction accounted for %18.5 whereas the ones with non ST segment elevation myocardial infarction were %23. On admission and at discharge %99, %80, %58 and %96.5 of patients received antiplatelet, beta blockers, ACEI/ARB and statins respectively. In general the extent of adherence to updated clinical guidelines on admission was 58.5 and at discharge 53.9 which was poor. Conclusions: Poor adherence to updated clinical guidelines by cardiologists due to secondary prevention of Acute Coronary Syndrome (ACS) is very worrisome. It is necessary to investigate the reasons of non-adherence regarding aging society and the prevalence of cardiac disease. PCV132 Penetration of Peripheral Vascular Interventions in Hungary Endrei D, Horváth L, Boncz I University of Pécs, Pécs, Hungary
Objectives: Our investigation aimed to analyse the penetration of peripheral vascular interventions among Hungarian hospitals, with special respect to the Clinical Center of the University of Pécs, a tertiary level university teaching hospital. Methods: Data analysed were taken from the database of the Hungarian National Health Insurance Fund Administration, covering the year 2015. We identified the patients with the Hungarian Diagnosis Related Groups (DRG) categories. We investigated the following DRG groups: 190 C, 190 D, 190 E, 190 F, 190 G, 190 H. Hospitals that had reported patients with these DRG codes were involved into the study. Our investigation focused on case numbers and percentage ratio. Results: The general market share of the Clinical Center of the University of Pécs (CC-UP) was 5.0 % from all the active inpatient care services in 2015. Institutions performing 190C Percutaneous and other vascular surgeries (with the implantation of one or more stents or homograft) reported a total 1111 cases, out of which 135 (12%, which is the second largest market share: 2nd place) was reported by the CC-UP. Institutions performing 190D Percutaneous and other vascular surgeries without stent implantation reported a total 592 cases, according to reported performance, the CC-UP had 229 cases (38.7%, 1st place). Regarding 190E Percutaneous vascular surgeries with further treatment (with one or more stents) the reported number was a total of 1288 cases, out of which the CC-UP carried out 7 (0.5%, 28th place). The total number of 190F Percutaneous vascular surgeries without further treatment including stent implantation amounted to 822, and the CC-UP had 29 cases (3.5 %, 9th place). Conclusions: The case numbers and percentage ratio of peripheral vascular interventions performed at hospitals showed considerable differences, even in a tertiary level teaching hospital. Penetration rate of peripheral vascular interventions should be increased in Hungary. PCV133 Intermediate Evaluation of Vivoptim: The Mgen (French Insurer) Prevention Program for Cardiovascular Risks Blachier M1, Vimont A1, Ballouk S2, Le Lann A2, Femery V2 1PUBLIC HEALTH EXPERTISE, Paris, France, 2MGEN, Paris, France
Objectives: VIVOPTIM is an innovative prevention program for cardiovascular (CV) risks designed and financed by the French insurer MGEN Union. It is a personalized program based on digital services, telemedicine devices and direct coaching. A pilot program was launched in 2015 in two French regions (Midi Pyrénées and Bourgogne). A total of 15 different prevention programs were proposed: obesity, atherosclerosis, hypertension, physical activity… based on their CV risk profile. An evaluation of VIVOPTIM after 10 months of follow up was conducted. Methods: