Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices.
OBJECTIVE
To examine adherence to guideline-concordant hypertension treatment practices at community health centers (CHCs) compared with private physicians' offices.


METHODS
National Ambulatory Medical Care Survey from 2006 to 2010.


METHODS
We examined four guideline-concordant treatment practices: initiation of a new medication for uncontrolled hypertension, use of fixed-dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on ≥3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHC with private physicians' offices overall and by payer group.


METHODS
We identified visits of nonpregnant adults with hypertension at CHCs and private physicians' offices.


RESULTS
Medicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension (AOR 1.0, 95 percent CI: 0.6-1.9), whereas Medicaid patients at private physicians' offices were less likely to receive a new medication (AOR 0.3, 95 percent CI: 0.1-0.6). Use of fixed-dose combination drugs was lower at CHCs (AOR 0.6, 95 percent CI: 0.4-0.9). Thiazide use for patients was similar in both settings (AOR 0.8, 95 percent CI: 0.4-1.7). Use of aldosterone antagonists was too rare (2.1 percent at CHCs and 1.5 percent at private clinics) to allow for statistically reliable comparisons.


CONCLUSIONS
Increasing physician use of fixed-dose combination drugs may be particularly helpful in improving hypertension control at CHCs where there are higher rates of uncontrolled hypertension.
Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA.
Valy
http://orcid.org/0000-0003-0795-3237
V
Fontil
Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.|UCSF Center for Vulnerable Populations at San Francisco General Hospital, San Francisco, CA.|Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
Kirsten
K
Bibbins-Domingo
Divisions of General Internal Medicine and Outcomes and Health Services Research, UT Southwestern, Dallas, TX.
Oanh Kieu
OK
Nguyen
Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
David
D
Guzman
Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA.
Lauren Elizabeth
LE
Goldman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003151:Community Health Centers / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000458:organization & administration / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D011331:Private Practice / Q000592:standards*; D064876:Safety-net Providers / Q000592:standards*; D014481:United States; D055815:Young Adult
D000959:Antihypertensive Agents
Hypertension; clinical inertia; community health centers; fixed-dose combination; single-pill combination; treatment intensification