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Effect of unrelated comorbid conditions on hypertension management
Barbara J Turner1, Christopher S Hollenbeak, Mark Weiner
1University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6021, USA. bturner@mail.med.upenn.edu
Annals of Internal Medicine
|April 17, 2008
Summary
Patients with more unrelated comorbid conditions received less treatment intensification for uncontrolled hypertension. This highlights a potential gap in primary care quality-of-care for complex patients.
Area of Science:
- Primary Care Medicine
- Health Services Research
- Clinical Quality Measurement
Background:
- Quality of care assessment can be influenced by the relationship between a patient's comorbid conditions and specific health measures.
- Unrelated comorbid conditions may impact the management of chronic diseases during single-visit assessments.
Purpose of the Study:
- To investigate the association between unrelated comorbid conditions and the treatment of uncontrolled hypertension in primary care settings.
- To determine if the presence of unrelated health issues affects hypertension management intensification.
Main Methods:
- Analysis of a large electronic medical record database from 6 primary care practices in Philadelphia.
- Inclusion of 15,459 patients with uncontrolled hypertension and 70,557 visits over a three-year period.
- Utilized generalized estimating equation logistic regression to assess treatment intensification, adjusting for patient, healthcare, and provider factors.
Main Results:
- Patients averaged 2.2 unrelated comorbid conditions per visit.
- The likelihood of antihypertensive treatment intensification decreased significantly with an increasing number of unrelated comorbid conditions.
- This association remained consistent across visit, patient, and provider levels (P < 0.001).
Conclusions:
- Patients with a higher burden of unrelated comorbid conditions were less likely to have their uncontrolled hypertension addressed.
- The underlying reasons for this disparity in care require further investigation.
- Further research is needed to understand the impact of diverse comorbid conditions on achieving quality-of-care targets.
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