. "5 Interventions Directed at Individuals with Hypertension." A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Washington, DC: The National Academies Press, 2010.
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A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension
hypertension screening, follow-up care, and the use of medication (Moy et al., 1995). Data from the 1990 National Health Interview Survey (NHIS) showed a strong association between seeing a physician in the past year and taking action to control hypertension (taking medication, reducing salt, reducing weight) (CDC, 1994). Similarly, in an analysis of the NHANES (National Health and Nutrition Examination Survey) III, He et al. (2002) found that the percentage of persons with controlled hypertension was higher for those who visited the same facility (Odds Ratio [OR] = 2.77 [1.88-4.09]) or saw the same provider (OR = 2.29 [1.74-3.02]) for their health care. Another study reported that severe, uncontrolled hypertension was more common among Medicaid patients who could not identify a source of care (Lurie et al., 1984).
A few case control studies have reported similar findings. Shea et al. (1992b) found that severe, uncontrolled hypertension was more common among those who did not have a primary care physician (adjusted OR = 3.5 [1.6-7.7]) and those who did not comply with antihypertensive treatment (adjusted OR = 1.9 [1.4-2.5]). Ahluwalia and colleagues (1997) also found that controlled hypertension was associated with having a regular place of care (OR = 7.93 [3.86-16.29]. In a study of medically stable Department of Veterans Affairs (VA) patients terminated from regular outpatient care, compared with those retained in care, 41 percent of discharged patients had blood pressure that was uncontrolled compared to 5 percent at the time of discharge; blood pressures were taken 13 months after discharge (p < 0.001) (data for the control group were 17 percent at follow-up vs. 9 percent, a nonsignificant difference). Among discharged patients with diagnosed hypertension, systolic blood pressure rose an average of 11.2 mm Hg; diastolic blood pressure rose an average of 5.6 mm Hg (p < 0.001). Of the discharged group, 47 percent reduced their prescription medications compared with 25 percent in the control group (p = 0.002) (Fihn and Wicher, 1988).
Another study found that one of the factors associated with a hospitalization due to noncompliance with medication (medications included an ACE [angiotensin-converting enzyme] inhibitor) was the number of physicians seen regularly (p = 0.007). The adjusted OR for seeing a greater number of physicians was 2.0 (p < 0.005) (Col et al., 1990).
On the other hand, Kotchen and colleagues reported that neither having seen a provider within the past three months (p > 0.4) nor receiving care from the same provider at each encounter (p > 0.8) was associated with improved hypertension control (Kotchen et al., 1998). Similarly, Stockwell and colleagues found that a greater number of physician visits was not associated with awareness of hypertension, the number of antihypertensive drug days, or blood pressure control (Stockwell et al., 1994).
One of the reasons for the lack of a consistent association between