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A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data
Lillian Min1,2,3,4, Jin-Kyung Ha2, Carole E Aubert3,4,5,6
1Veterans Affairs Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Medical Center, Ann Arbor, Michigan.
JAMA Network Open
|January 15, 2021
Summary
Health system pharmacy data accurately quantifies hypertension treatment intensity in older adults. This method, combined with blood pressure (BP) measurements, aids in optimizing hypertension management and improving patient care.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Health Services Research
Background:
- Hypertension treatment intensity is often overlooked, focusing solely on blood pressure (BP) targets.
- High-intensity treatment can increase patient burden and risks, especially in older adults.
- Previous methods identified intense treatment using BP and medication counts from administrative data.
Purpose of the Study:
- To refine and validate a method for precisely quantifying hypertension treatment dose intensity.
- To utilize solely health system administrative pharmacy fill data for this quantification.
Main Methods:
- An observational, cross-sectional study of older veterans in the Veterans Health Administration.
- Developed a Hypertension Daily Dose (HDD) calculation using pharmacy fill data, accounting for refill delays.
- Correlated pharmacy-derived HDDs with clinician-noted HDDs from medical records.
Main Results:
- Pharmacy HDDs showed a high correlation (r=0.92) with clinically noted HDDs (mean 2.7 vs. 2.8).
- The method accurately identified high-intensity treatment, with C statistics ranging from 92.8% to 88.1% for increasing numbers of medications.
- Study included 316 male veterans with a mean age of 75.6 years.
Conclusions:
- Health system pharmacy data can reliably quantify hypertension regimen dose intensity.
- This validated tool, alongside BP data, can support research and quality improvement in hypertension management for older adults.
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