Variations in hypertension control in indigent rural primary care clinics in North Carolina.
OBJECTIVE
To examine blood pressure control and prescribing practices in the treatment of hypertension, including the use of sample medications, in rural populations.


METHODS
Retrospective chart review of 296 hypertensive patients and surveys of primary care providers serving these patients.


METHODS
Twenty-seven rural, primary care clinics in North Carolina.


METHODS
Blood pressure control, with the practice site as the unit of analysis.


RESULTS
An average of 29% of patients per clinic had blood pressures that were inadequately controlled. Wide variations existed between clinics in blood pressure control and medication costs. Thirty-two percent of all blood pressure medications used were either angiotensin converting enzyme inhibitors or calcium channel blockers compared with 26% use of diuretics. Virtually all clinics used sample antihypertensive agents and reported that sample medications were an important source of free medications for their indigent patients. Reported sample use by practice was positively correlated with the mean daily hypertensive medication costs. Variations in blood pressure control were not explained by any measured variables, although the sample size was small.


CONCLUSIONS
Large variations exist within rural North Carolina primary care clinics in blood pressure control and medication costs. We need to study further the relationships of new antihypertensive agents, medication costs, and sample use with blood pressure control, health care costs, and other patient outcomes.
Goldstein
A O
AO
Primary Care Research Fellowship Program, University of North Carolina at Chapel Hill.
Carey
T S
TS
Levis
D
D
Madson
S
S
Bernstein
J
J
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003151:Community Health Centers / Q000191:economics / Q000592:standards*; D015986:Confounding Factors, Epidemiologic; D003266:Continuity of Patient Care; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000517:prevention & control*; D008297:Male; D008489:Medical Indigency / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010349:Patient Compliance; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D012189:Retrospective Studies; D012423:Rural Health / Q000592:standards*; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics