Journal
HEALTH SERVICES RESEARCH
Volume 52, Issue 2, Pages 807-825Publisher
WILEY
DOI: 10.1111/1475-6773.12516
Keywords
Hypertension; community health centers; clinical inertia; treatment intensification; fixed-dose combination; single-pill combination
Funding
- UCSF Center for Vulnerable Populations at the Zuckerberg San Francisco General Hospital
- UCSF Division of General Internal Medicine
- UT Southwestern Center for Patient-Centered Outcomes Research
- AHRQ [5K08HS018090, U54NS081760 NIH/NINDS]
- NINDS [U54NS081760]
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ObjectiveTo examine adherence to guideline-concordant hypertension treatment practices at community health centers (CHCs) compared with private physicians' offices. Data Sources/Study SettingNational Ambulatory Medical Care Survey from 2006 to 2010. Study DesignWe examined four guideline-concordant treatment practices: initiation of a new medication for uncontrolled hypertension, use of fixed-dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on 3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHC with private physicians' offices overall and by payer group. Data Collection/Extraction MethodsWe identified visits of nonpregnant adults with hypertension at CHCs and private physicians' offices. Principal FindingsMedicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension (AOR 1.0, 95 percent CI: 0.6-1.9), whereas Medicaid patients at private physicians' offices were less likely to receive a new medication (AOR 0.3, 95 percent CI: 0.1-0.6). Use of fixed-dose combination drugs was lower at CHCs (AOR 0.6, 95 percent CI: 0.4-0.9). Thiazide use for patients was similar in both settings (AOR 0.8, 95 percent CI: 0.4-1.7). Use of aldosterone antagonists was too rare (2.1 percent at CHCs and 1.5 percent at private clinics) to allow for statistically reliable comparisons. ConclusionsIncreasing 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.
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