title: Receipt of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers among Medicare Beneficiaries with Diabetes and Hypertension.
abstract: OBJECTIVE
  The proportion of patients with diabetes and hypertension receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARB), is one of the quality measures for medication management employed by the Centers for Medicare and Medicaid Services to rate Medicare Part D plans. The objectives of this study were to determine the rate and predictors of receiving ACE/ARB in physician office and outpatient visits made by Medicare beneficiaries with diabetes and hypertension.
  
  
  METHODS
  The study population was Medicare beneficiaries with diabetes and hypertension from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey Outpatient Department, from 2007 to 2009. Predictors of receiving ACE/ARB were determined using bivariate and multivariate logistic regression analysis.
  
  
  RESULTS
  Of the 6,311 Medicare outpatient and physician office visits with hypertension and diabetes, 40.70% patient visits were associated with receiving ACE/ARB. Bivariate analysis found that higher proportions of ACE/ARB were received during visits made to primary care physicians compared to visits to non-primary care physicians (48.39% vs. 32.56%; p<0.05). Adjusted multivariate analyses indicated that ACE/ARB were more likely to be received during visits to primary care physicians than visits to non-primary care physicians (odds ratio [OR]: 1.96; 95% confidence interval [CI]: 1.59-2.43), and ACE/ARB were more likely to be received during visits by patients residing in zip codes with median household income within Quartile 2 ($32,794-$40,626), compared to visits by patients residing in zip codes with median household income within Quartile 1 (< $32,793, OR: 1.45; 95% CI: 1.13-1.87).
  
  
  CONCLUSIONS
  Fewer than half of the patient visits were associated with receiving ACE/ARB. Promoting evidence-based medicine and increasing access to primary care may have the potential to increase the rates of receiving ACE/ARB in this population.
authors.affiliation: Department of Clinical Pharmacy University of Tennessee College of Pharmacy Memphis, TN 38163.
authors.forename: Junling
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Clinical Pharmacy University of Tennessee College of Pharmacy Memphis, TN 38163 Tel: 901-448-3521 ssurbhi@uthsc.edu.
authors.forename: Satya
authors.initials: S
authors.lastname: Surbhi
authors.affiliation: Pharmacy Quality Alliance, Inc. Tel: 515-554-6685 jkuhle@pqaalliance.org.
authors.forename: Julie W
authors.initials: JW
authors.lastname: Kuhle
keywords: Angiotensin II Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Diabetes; Hypertension; Medicare