title: Primary care physician visits by patients with incident hypertension.
abstract: BACKGROUND
  Access to a primary care physician (PCP) improves health outcomes among patients with hypertension. The study objective was to compare PCP use among patients with incident hypertension with and without comorbidities.
  
  
  METHODS
  Hypertensive patients newly diagnosed between April 1, 1998 and March 31, 2009 were identified using Alberta administrative databases. Three comorbidity subgroups were defined: (1) none, (2) vascular risk related, and (3) unrelated. The number of PCP visits was calculated using zero-inflation Poisson regression, with time trends compared using the χ(2) test. A Cox model was used to assess the association between PCP use and clinical outcomes.
  
  
  RESULTS
  Of 456,263 newly diagnosed hypertensive patients (mean age, 57.6 years; 50.6% men; 62.5% no comorbidity), 88% had seen a PCP in the year before diagnosis, and 94% had seen a PCP in the year after being diagnosed. Compared with before diagnosis, the mean number of PCP visits increased after diagnosis (none, 3.95 vs 6.15; vascular risk related, 6.45 vs 7.99; and unrelated, 6.76 vs 8.24). Over the study period, the frequency of PCP visits before diagnosis was constant, and there was a statistically significant decline in the adjusted mean number of visits after diagnosis. Those with higher PCP use were less likely to die but more likely to be hospitalized regardless of comorbidity.
  
  
  CONCLUSIONS
  The frequency of PCP visits was high before and after diagnosis. Increased PCP use was associated with a lower risk of death; however, it does increase the costs of caring for patients with hypertension. Therefore, future studies are necessary to determine the optimal level required to achieve cost-effective use of PCP resources.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Public Health, University of Calgary, Calgary, Alberta, Canada. Electronic address: fclement@ucalgary.ca.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Clement
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Guanmin
authors.initials: G
authors.lastname: Chen
authors.affiliation: Division of General Internal Medicine, University of British Columbia, British Columbia, Vancouver, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Khan
authors.affiliation: Department of Family and Community Medicine, University of Toronto/Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pharmacology and Therapeutics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Norm R C
authors.initials: NR
authors.lastname: Campbell
authors.affiliation: Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Division of General Internal Medicine, University of Alberta, Edmonton, Ontario, Canada.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data* / Q000639:trends; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries; D017678:Sex Distribution