Abstract P351: Clinician Continuity And Confirmatory Blood Pressure Measurement Lead To Higher Rates Of Antihypertensive Therapeutic Intensification

Abstract

Background: Evidence supports treatment intensification (TI) as the most important factor impacting BP control. In our modeling of TI from EHR data, 13.2% of variance in TI could be explained. Care process-related factors that influence the rate of antihypertensive (AH) TI are particularly important for informing population-level hypertension control efforts, especially those that are modifiable. This study examines previously unstudied care-process variables: confirmatory (c, repeated) cBP measurement and clinician consistency; and their relationship with TI. Methods: Data for defining and modeling AH TI comes from ambulatory primary care clinics at five distinct health care organizations. Mixed-effects logistic regression was used to model the relationship between cBP, clinician consistency, and TI at visits with uncontrolled BP (≥140/≥90 mmHg). Results: “Primary clinician” is defined as the clinician most frequently seen by each patient at all primary care visits in the last two years. Visits with cBP measurement had 56.6% greater odds of TI and explained 1.1% of the variance in TI. Visits with a patient’s primary clinician had 55.9% greater odds of TI, accounting for ~1% of variance in TI. Conclusion: Repeat or cBP measurements increase the rate of TI as does current and prior visits with the primary clinician, but collectively account for only ~2% of variance in the rate of TI. Increasing continuity of care with the primary provider and frequency of repeated BP values at encounters when BP is uncontrolled could improve the low rate of TI, although other interventions are clearly needed.