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Improving medication adherence in a southeastern hypertension clinic using adhererx
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POSTERS: Patient-Provider-Healthcare System Issues
P-515 EFFECT OF MEDICATION COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY ON BLOOD PRESSURE CONTROL Philip P Gerbino, Brian S Nightengale, Thomas J Bramley, Feride Frech. University of the Sciences in Philadelphia, Philadelphia, PA; Applied Health Outcomes, Tampa, FL; Novartis Pharmaceuticals Corporation, East Hanover, NJ. Established guidelines in the US set the BP goal to ⬍140/90 mm Hg for patients with uncomplicated hypertension. Only 31% of all treated and untreated hypertensive individuals are controlled to this level. Among treated patients, only 53% are controlled to ⬍140/90 mm Hg, and only 25% of patients with diabetes are controlled to a goal level of ⬍130/85 mm Hg. This study was conducted to evaluate the relationship between medication compliance and BP control in a hypertensive population receiving antihypertensive therapy. Medical and pharmacy claims from 13 US health plans were analyzed, and data from 840 subjects were collected from randomly selected subjects per HEDIS BP control technical specifications from 1999 to 2002. Subjects were selected if they 1) received monotherapy or fixed-dose combination therapy during the time BP was measured; 2) had ⱖ3 antihypertensive prescriptions prior to BP measurement; and 3) had ⱖ1 antihypertensive prescriptions after BP was measured. Control of BP was defined according to guidelines of the sixth report of the Joint National Committee: ⬍140/90 mm Hg and ⬍130/85 mm Hg for subjects with diabetes. Compliance was measured using the medication possession ratio (MPR), defined as days supply/length of therapy. MPR was used to stratify patients into compliance levels according to the following criteria: high (ⱖ80%), medium (ⱖ50%–79%), and low (⬍50%). The relationship between compliance and BP control was assessed using a logistic regression model. Among the 840 subjects studied, mean age was 59 y, and 55% were women. The majority of subjects were receiving an angiotensin-converting enzyme inhibitor (27%), a calcium channel blocker (22%), a beta-blocker (20%), or a diuretic (11%). Level of BP control was 43% in high vs 34% in medium and 33% in low compliance groups. Highly compliant patients were 42% more likely to achieve BP control than those with medium to low compliance after controlling for age, gender, and comorbidities (OR⫽1.42; P⫽.036). Additionally, increasing number of nonantihypertensive medications was associated with worse compliance (OR⫽.95; P⫽.004). These results demonstrate that compliance with antihypertensive medications is associated with BP control in subjects receiving monotherapy. Key Words: Antihypertensive Therapy, Hypertension, Medication Compliance
P-516 IMPROVING MEDICATION ADHERENCE IN A SOUTHEASTERN HYPERTENSION CLINIC USING ADHERERX Deborah S. King, Stephanie J. Barud, Marion R. Wofford, Sara L. Noble, Tibb M. Fontenot, Rebecca R. Reed, Kimberly G. Harkins, Jimmy L. Stewart, Sharon B. Wyatt, Angee McDaniel. Division of Hypertension, University of Mississippi Medical Center, Jackson, MS; Pfizer, Inc., Jackson, MS. A major barrier to optimal drug therapy is the lack of adherence to prescribed regimens. It is estimated that up to 85% of patients fail to use medications correctly. Adherence with treatment recommendations is dependent on many factors and varies among patients. These factors include patient, provider, and medication-related factors, as well as environmental and health care system issues. Recent clinical guidelines highlight the imperative need to focus on adherence issues. This presentation will describe the implementation of a web-based database, Adher0895-7061/04/$30.00
AJH–May 2004 –VOL. 17, NO. 5, PART 2
eRx, for tracking patient adherence and individualizing education strategies. The UMMC Hypertension Clinic is a multidisciplinary clinic providing services for 5000⫹ persons. Routine care includes careful attention to well recognized barriers to adherence including patient knowledge and participation, costs, dosage schedules, and adverse effects. Because of this multidisciplinary focused approach to adherence issues, documented adherence in this clinic exceeds usual reported rates. This project is a continuation of a previous investigation conducted at the same site and initiated to further enhance and assess both patient and provider medication adherence practices. Patient reported adherence to medications is assessed using a simple questionnaire, the Morisky scale. This standardized, validated instrument consisting of 4 questions addressing medication practices is administered to all willing clinic patients. Results are entered and scored in the AdhereRx database. The AdhereRx program is customized for clinic and provider preferences. Based on the Morisky score, disease state, and health recommendations, the provider selects appropriate educational materials from the website for individual patient. Adding additional support to the Morisky assessment by incorporating AdhereRx has further enhanced and improved both adherence and patient-provider encounters. Assessing patterns of adherence in this specialty clinic population helps health care providers guide and focus educational efforts on individual drug therapy and globally identify effective measures that may be translated into other practices. This presentation will describe and highlight this process. Key Words: Adherence, Education, Medications
P-517 CORRELATES OF HYPERTENSION CONTROL IN A PRIMARY CARE SETTING Thomas G. Majernick, Nancy A. Madden, Christopher Zacker, Daniel A. Belletti, Stephen Arcona. Family Practice, Primemed P.C., Olyphant, PA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Clinical Process Improvement Associates, Lehigh Valley, PA. The purpose of this retrospective study is to describe hypertension control and its predictors, using data from a convenience sample of 631 adult patients drawn from an established primary care practice. Data were obtained through retrospective chart review and patient survey during a three month study period. Blood pressure (BP) control, defined as systolic ⬍140mmHg and diastolic ⬍90 mmHg, (subjects with Diabetes Mellitus (DM) SBP ⬍ 130mmHg and DBP ⬍ 80mmHg), was used as a dichotomous outcome variable in a logistic regression model identifying significant demographic and clinical predictors of control. In our sample, 53% of the cohort were age ⬎64, and 28.5% were age ⬎74. 41% were obese and 80% were overweight. 20% had DM, and 12% impaired fasting glucose (IFG). The mean number of antihypertensive medications used in treatment was 1.8. Patients of low, moderate and high Framingham Risk Score (FRS) were treated with 1.4, 1.6, and 2.3 medications respectively. Women on average received 1.94 drugs verses 1.74 in men. Patients with IFG were treated with an average of 2.0 antihypertensive medications, and patients with DM 2.27. Compared to patients with a low FRS, patients with moderate and high scores had progressively reduced odds of having controlled blood pressure, (69% reduction, 95% CI⫽0.19, 0.65; 82% reduction, 95% CI⫽0.10, 0.36, respectively). Being female reduced the odds of achieving BP control by 61% (95% CI⫽0.26,0.66). Having diabetes (95% CI⫽0.21, 0.79) or IFG (95% CI⫽0.10, 0.40) reduced the odds of control by 64% and 82% respectively. For each additional point on a patient knowledge Likert scale, the odds of having controlled BP increased by 78% (95% CI⫽1.44, 2.56). Each additional comorbid condition positively associated with control, (34% increase in odds, 95% CI⫽1.15,1.86). Age - odds ratio 0.99 (95% CI⫽0.98,1.02) and BMI - odds ratio 1.00 (95% CI⫽0.97,1.04) did not correlate with control. © 2004 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.
POSTERS: Patient-Provider-Healthcare System Issues
P-515 EFFECT OF MEDICATION COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY ON BLOOD PRESSURE CONTROL Philip P Gerbino, Brian S Nightengale, Thomas J Bramley, Feride Frech. University of the Sciences in Philadelphia, Philadelphia, PA; Applied Health Outcomes, Tampa, FL; Novartis Pharmaceuticals Corporation, East Hanover, NJ. Established guidelines in the US set the BP goal to ⬍140/90 mm Hg for patients with uncomplicated hypertension. Only 31% of all treated and untreated hypertensive individuals are controlled to this level. Among treated patients, only 53% are controlled to ⬍140/90 mm Hg, and only 25% of patients with diabetes are controlled to a goal level of ⬍130/85 mm Hg. This study was conducted to evaluate the relationship between medication compliance and BP control in a hypertensive population receiving antihypertensive therapy. Medical and pharmacy claims from 13 US health plans were analyzed, and data from 840 subjects were collected from randomly selected subjects per HEDIS BP control technical specifications from 1999 to 2002. Subjects were selected if they 1) received monotherapy or fixed-dose combination therapy during the time BP was measured; 2) had ⱖ3 antihypertensive prescriptions prior to BP measurement; and 3) had ⱖ1 antihypertensive prescriptions after BP was measured. Control of BP was defined according to guidelines of the sixth report of the Joint National Committee: ⬍140/90 mm Hg and ⬍130/85 mm Hg for subjects with diabetes. Compliance was measured using the medication possession ratio (MPR), defined as days supply/length of therapy. MPR was used to stratify patients into compliance levels according to the following criteria: high (ⱖ80%), medium (ⱖ50%–79%), and low (⬍50%). The relationship between compliance and BP control was assessed using a logistic regression model. Among the 840 subjects studied, mean age was 59 y, and 55% were women. The majority of subjects were receiving an angiotensin-converting enzyme inhibitor (27%), a calcium channel blocker (22%), a beta-blocker (20%), or a diuretic (11%). Level of BP control was 43% in high vs 34% in medium and 33% in low compliance groups. Highly compliant patients were 42% more likely to achieve BP control than those with medium to low compliance after controlling for age, gender, and comorbidities (OR⫽1.42; P⫽.036). Additionally, increasing number of nonantihypertensive medications was associated with worse compliance (OR⫽.95; P⫽.004). These results demonstrate that compliance with antihypertensive medications is associated with BP control in subjects receiving monotherapy. Key Words: Antihypertensive Therapy, Hypertension, Medication Compliance
P-516 IMPROVING MEDICATION ADHERENCE IN A SOUTHEASTERN HYPERTENSION CLINIC USING ADHERERX Deborah S. King, Stephanie J. Barud, Marion R. Wofford, Sara L. Noble, Tibb M. Fontenot, Rebecca R. Reed, Kimberly G. Harkins, Jimmy L. Stewart, Sharon B. Wyatt, Angee McDaniel. Division of Hypertension, University of Mississippi Medical Center, Jackson, MS; Pfizer, Inc., Jackson, MS. A major barrier to optimal drug therapy is the lack of adherence to prescribed regimens. It is estimated that up to 85% of patients fail to use medications correctly. Adherence with treatment recommendations is dependent on many factors and varies among patients. These factors include patient, provider, and medication-related factors, as well as environmental and health care system issues. Recent clinical guidelines highlight the imperative need to focus on adherence issues. This presentation will describe the implementation of a web-based database, Adher0895-7061/04/$30.00
AJH–May 2004 –VOL. 17, NO. 5, PART 2
eRx, for tracking patient adherence and individualizing education strategies. The UMMC Hypertension Clinic is a multidisciplinary clinic providing services for 5000⫹ persons. Routine care includes careful attention to well recognized barriers to adherence including patient knowledge and participation, costs, dosage schedules, and adverse effects. Because of this multidisciplinary focused approach to adherence issues, documented adherence in this clinic exceeds usual reported rates. This project is a continuation of a previous investigation conducted at the same site and initiated to further enhance and assess both patient and provider medication adherence practices. Patient reported adherence to medications is assessed using a simple questionnaire, the Morisky scale. This standardized, validated instrument consisting of 4 questions addressing medication practices is administered to all willing clinic patients. Results are entered and scored in the AdhereRx database. The AdhereRx program is customized for clinic and provider preferences. Based on the Morisky score, disease state, and health recommendations, the provider selects appropriate educational materials from the website for individual patient. Adding additional support to the Morisky assessment by incorporating AdhereRx has further enhanced and improved both adherence and patient-provider encounters. Assessing patterns of adherence in this specialty clinic population helps health care providers guide and focus educational efforts on individual drug therapy and globally identify effective measures that may be translated into other practices. This presentation will describe and highlight this process. Key Words: Adherence, Education, Medications
P-517 CORRELATES OF HYPERTENSION CONTROL IN A PRIMARY CARE SETTING Thomas G. Majernick, Nancy A. Madden, Christopher Zacker, Daniel A. Belletti, Stephen Arcona. Family Practice, Primemed P.C., Olyphant, PA; Novartis Pharmaceuticals Corporation, East Hanover, NJ; Clinical Process Improvement Associates, Lehigh Valley, PA. The purpose of this retrospective study is to describe hypertension control and its predictors, using data from a convenience sample of 631 adult patients drawn from an established primary care practice. Data were obtained through retrospective chart review and patient survey during a three month study period. Blood pressure (BP) control, defined as systolic ⬍140mmHg and diastolic ⬍90 mmHg, (subjects with Diabetes Mellitus (DM) SBP ⬍ 130mmHg and DBP ⬍ 80mmHg), was used as a dichotomous outcome variable in a logistic regression model identifying significant demographic and clinical predictors of control. In our sample, 53% of the cohort were age ⬎64, and 28.5% were age ⬎74. 41% were obese and 80% were overweight. 20% had DM, and 12% impaired fasting glucose (IFG). The mean number of antihypertensive medications used in treatment was 1.8. Patients of low, moderate and high Framingham Risk Score (FRS) were treated with 1.4, 1.6, and 2.3 medications respectively. Women on average received 1.94 drugs verses 1.74 in men. Patients with IFG were treated with an average of 2.0 antihypertensive medications, and patients with DM 2.27. Compared to patients with a low FRS, patients with moderate and high scores had progressively reduced odds of having controlled blood pressure, (69% reduction, 95% CI⫽0.19, 0.65; 82% reduction, 95% CI⫽0.10, 0.36, respectively). Being female reduced the odds of achieving BP control by 61% (95% CI⫽0.26,0.66). Having diabetes (95% CI⫽0.21, 0.79) or IFG (95% CI⫽0.10, 0.40) reduced the odds of control by 64% and 82% respectively. For each additional point on a patient knowledge Likert scale, the odds of having controlled BP increased by 78% (95% CI⫽1.44, 2.56). Each additional comorbid condition positively associated with control, (34% increase in odds, 95% CI⫽1.15,1.86). Age - odds ratio 0.99 (95% CI⫽0.98,1.02) and BMI - odds ratio 1.00 (95% CI⫽0.97,1.04) did not correlate with control. © 2004 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.