title: Clinical and nonclinical correlates of adherence to prescribing guidelines for hypertension in a large managed care organization.
abstract: To examine correlates of guideline adherence in a population with access to health care and prescription drug benefits, the authors conducted a cross-sectional analysis among 5789 patients undergoing hypertension treatment with a single medication in a large New England managed care organization. Logistic regression was used to determine correlates of adherence, defined as use of diuretics or beta blocker as antihypertensive monotherapy during the 1-year study period. Women were more likely than men to receive guideline-adherent therapy (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.45-1.85). Compared with patients covered by health maintenance organization plans, Medicare coverage was positively associated with guideline adherence (OR, 1.38; 95% CI, 1.13-1.69), but fee-for-service coverage was negatively associated (OR, 0.66; 95% CI, 0.48-0.91). Patient age was not a significant correlate of adherence to guidelines (OR, 1.01; 95% CI, 0.94-1.09). Understanding these observations may lead to strategies to improve guideline adherence and reduce health care disparities.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Skelding
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Ken
authors.initials: K
authors.lastname: Kleinman
authors.forename: Cheryl
authors.initials: C
authors.lastname: Warner
authors.forename: Susanne
authors.initials: S
authors.lastname: Salem-Schatz
authors.forename: Irina
authors.initials: I
authors.lastname: Miroshnik
authors.forename: Lisa
authors.initials: L
authors.lastname: Prosser
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D009513:New Hampshire; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012237:Rhode Island; D017678:Sex Distribution
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics