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Hypertension, insurance claim review, pharmaceutical use
Previous research has documented low levels of persistence with prescribed hypertension treatment in Canada. With growing recognition of the value of appropriate drug therapy, rates of persistence may be improving over time. The purpose of this study was to examine persistence with prescribed hypertension treatment among newly treated community-dwelling seniors in British Columbia.
BC PharmaCare data was used to determine the cohort of seniors who were newly-treated hypertensives over the period 1993 to 2000. Medical and hospital claims from the BCLHD were searched for diagnoses indicating the presence of essential hypertension and potentially confounding conditions. Rates of persistence with drug therapy were analysed, accounting for patient, age, sex, clinical complexity, the existence of potentially confounding conditions, and type of drug first prescribed.
For the period 1993 to 2000, 82,824 seniors were identified as new users of hypertension drugs with diagnosed essential hypertension. Fifty-one percent of these newly-treated hypertensives filled a contiguous series of hypertension prescriptions for at least one full year. There was a slight improvement in the rate of persistence over time (p<0.001). Evidence of specific co-morbidities that potentially complicate essential hypertension increased the likelihood of persistence among first-time users (p<0.001), whereas greater overall clinical complexity decreased the likelihood of persistence (p<0.001). Persistence was highest amongst patients initiated on newer anti-hypertensive drug therapies.
Despite modest improvement, persistence with hypertension treatment among the elderly is very low. Further research into the reasons for non-persistence would be advanced through primary data collection, including survey-based research. New policies and practices are needed to encourage persistence with evidence-based therapies.
2. Ogilvie RI, Burgess ED, Cusson JR, Feldman RD, Leiter LA, Myers MG. Report of the Canadian Hypertension Society Consensus Conference: Part 3. Pharmacologic treatment of essential hypertension. CMAJ 1993; 149(5):575-84.
3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jr., et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289(19):2560-72.
4. ICES. Management of Hypertension: Diagnosis, Evaluation, When to Treat and Non- Pharmacological Therapy. Toronto: Institute for Clinical Evaluative Sciences http://www.ices.on.ca/docs/fb1420.htm [Accessed 9/25/98]; 1998.
5. Caro JJ, Speckman JL, Salas M, Raggio G, Jackson JD. Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data. CMAJ 1999; 160(1):41-46.
6. Caro JJ, Salas M, Speckman JL, Raggio G, Jackson JD. Persistence with treatment for hypertension in actual practice. CMAJ 1999;
7. Johns Hopkins University. ACG Software Documentation & Users Manual. Baltimore, MD: Johns Hopkins University; 2001.
8. Jackevicius CA, Mamdani M, Tu JV. Adherence With Statin Therapy in Elderly Patients With and Without Acute Coronary Syndromes. JAMA
9. Metge C, Kozyrskyj AL, Roos N. Pharmaceuticals: focusing on appropriate utilization. Winnipeg: Manitoba Centre for Health Policy; 2003.
10. Morgan SG, Mintzes B, Barer M. The economics of direct-to-consumer advertising of prescription- only drugs: prescribed to improve consumer welfare? Journal of Health Services Research and Policy 2003; 8(4):237.
11. HSURC. Adherence to Cholesterol-Lowering Drugs in Saskatchewan. Saskatoon: Health Services Utilization and Research Commission;