Physician assessments of medication adherence and decisions to intensify medications for patients with uncontrolled blood pressure: still no better than a coin tossReportar como inadecuado

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BMC Health Services Research

, 12:270

Organization, structure and delivery of healthcare


BackgroundMany patients have uncontrolled blood pressure BP because they are not taking medications as prescribed. Providers may have difficulty accurately assessing adherence. Providers need to assess medication adherence to decide whether to address uncontrolled BP by improving adherence to the current prescribed regimen or by intensifying the BP treatment regimen by increasing doses or adding more medications.

MethodsWe examined how provider assessments of adherence with antihypertensive medications compared with refill records, and how providers’ assessments were associated with decisions to intensify medications for uncontrolled BP. We studied a cross-sectional cohort of 1169 veterans with diabetes presenting with BP ≥140-90 to 92 primary care providers at 9 Veterans Affairs VA facilities from February 2005 to March 2006. Using VA pharmacy records, we utilized a continuous multiple-interval measure of medication gaps CMG to assess the proportion of time in prior year that patient did not possess the prescribed medications; CMG ≥20% is considered clinically significant non-adherence. Providers answered post-visit Likert-scale questions regarding their assessment of patient adherence to BP medications. The BP regimen was considered intensified if medication was added or increased without stopping or decreasing another medication.

Results1064 patients were receiving antihypertensive medication regularly from the VA; the mean CMG was 11.3%. Adherence assessments by providers correlated poorly with refill history. 211 20% patients did not have BP medication available for ≥ 20% of days; providers characterized 79 37% of these 211 patients as having significant non-adherence, and intensified medications for 97 46%. Providers intensified BP medications for 451 42% patients, similarly whether assessed by provider as having significant non-adherence 44% or not 43%.

ConclusionsProviders recognized non-adherence for less than half of patients whose pharmacy records indicated significant refill gaps, and often intensified BP medications even when suspected serious non-adherence. Making an objective measure of adherence such as the CMG available during visits may help providers recognize non-adherence to inform prescribing decisions.

KeywordsAdherence Hypertension Diabetes Veterans Quality improvement Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-12-270 contains supplementary material, which is available to authorized users.

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Autor: Jennifer Meddings - Eve A Kerr - Michele Heisler - Timothy P Hofer


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