title: Management of cardiovascular risk in the usual care of Medicaid recipients.
abstract: Uncontrolled risk factors contribute substantially to cardiovascular disease burden. With retrospective chart review, we examined rates of cardiovascular risk factor assessment and intervention during the course of usual care for a representative sample of 3,742 adult North Carolina Medicaid recipients with diagnosed hypertension managed by a primary care provider. Most patients had been established with their provider for at least three years. Ninety-six percent had multiple modifiable risk factors. Blood pressure and cholesterol were above goal for 52.9% and 37.2% of patients, respectively. Among those with uncontrolled blood pressure, only 44.3% had intensification of therapy within the prior year. Half of patients with cholesterol above goal were treated with medication; and half of current smokers had documented advice to quit. Documentation of aspirin use or counseling was rare. Despite Medicaid coverage and access to care, many effective strategies to prevent cardiovascular events were underutilized, even among patients at highest risk.
authors.affiliation: North Carolina Community Care Networks, Inc., Raleigh, NC 27607, USA. adubard@n3cn.org
authors.forename: C Annette
authors.initials: CA
authors.lastname: DuBard
authors.forename: Dorothee
authors.initials: D
authors.lastname: Schmid
authors.forename: Susan
authors.initials: S
authors.lastname: Bostrom
authors.forename: Angie
authors.initials: A
authors.lastname: Yow
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Viera
authors.forename: Sara
authors.initials: S
authors.lastname: Huston
authors.forename: William
authors.initials: W
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009657:North Carolina; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult