Payment status influences hypertension control rates in a family medicine clinic

Objectives:

Adherence to prescribed regimens is an important factor in the management of hypertension.  With rising costs of medications, a patient’s ability to pay is a constant barrier to adherence with their prescribed therapies. Primary objective of this study was to evaluate whether medication payment status (Medicaid, private insurance or self pay) influences blood pressure control rates in a family medicine clinic.  Secondary objectives were to evaluate impact of payment status on stage of hypertension as well as on blood pressure values.

Methods:

A retrospective chart review was conducted including patients with a diagnosis of benign essential hypertension (ICD-9 401.1) and seen in clinic between January 1, 2011 and July 1, 2011.  Patients were excluded if there was not at least one documented blood pressure during the specified time period.  Data collected included: age, payment status, and lowest recorded blood pressure value. A convenience sample of 150 patients was selected with 50 patients in each group (Louisiana Medicaid, private insurance, and self pay).  JNC 7 guidelines were used to classify blood pressure stages and goals. A chi-square test was performed on blood pressure goal and classification.  Continuous variables were compared using ANOVA. 

Results:

Significant differences were found between insurance vs. self pay (p=0.006) and insurance vs. Medicaid (p=0.02).  ANOVA results showed no significant differences in systolic blood pressure between groups.  However, there was a significant difference seen in diastolic blood pressure with insurance vs. free care and insurance vs. Medicaid. 

Conclusion:

It appears that payment status can influence blood pressure control rates.   In order to maximize blood pressure control, providers should be aware of a patient’s method of paying for prescriptions prior to selecting a medication regimen.