Abstract 148: Are Disease Management Programs Associated With adherence to JNC-7 Hypertension Guidelines? A nationally representative Analysis Using the 2007 National Ambulatory Medical Care Survey

Abstract

Adherence to evidence-based treatment guidelines like JNC7 can improve hypertension outcomes. Identifying factors associated with adherence is important. Disease management programs (DMP) enroll patients and healthcare providers to set management goals, examine progress and receive feedback from members of the healthcare team. DMP enrollment has shown to improve clinical outcomes for diabetes, hypertension (HTN), and hyperlipidemia. We assessed the hypothesis that DMP enrollment is associated with adherence to JNC7 recommendations of lifestyle modification for pre-HTN or appropriate medications for stage 1 or stage 2 HTN. We analyzed nationally representative data from the 2007 National Ambulatory Care Survey that captures patient visit information from ambulatory care services across the US. Our study sample included men and non-pregnant women, > 18 years old, with a diagnosis of HTN, and a recorded blood pressure. JNC7 class was assigned by recorded blood pressure. We examined the association of enrollment in a DMP with the recommendation of lifestyle modifications and provider prescription of indicated drug class per JNC7. Overall JNC7 adherence was determined by using a composite endpoint defined as lifestyle adherence for pre-HTN and drug class adherence as specified by JNC7 guidelines. Logistic regression incorporated survey weights to reflect a nationally representative sample. Our study population was obtained from 32,778 visits in the NAMCS representing 170 million patient visits. The mean age was 63.4 years, 55.0% women and 15.4% of the patient visits were enrolled in a DMP. After adjusting for sex and age, pre-HTN patients enrolled in a DMP had 4.36 times the odds of utilizing lifestyle modifications [95% CI 3.01, 6.32]; DMP enrolled patients had 1.95 times the odds of being adherent to their specific JNC7 drug class guideline [95% CI 1.42, 2.68]; and 2.69 times the odds of being overall JNC7 adherent compared to those who were not enrolled [95% CI 2.06, 3.50]. Enrollment in a DMP is associated with improved adherence to lifestyle interventions in pre-HTN patients and drug adherence in patients with indicated drug class therapy. It is reasonable to consider outcome improvement from improved adherence to evidence based guidelines.