Low Adherence to Post Emergency Department Follow-Up Among Hypertensive Patients With Medical Insurance.

Abstract

Improvement in hypertension control in the insured, adult population could improve morbidity and mortality associated with hypertension in the United States. The emergency department (ED) is a potential site of intervention, where individuals are diagnosed with asymptomatic hypertension and referred to primary care. To inform intervention strategies, we identified risk factors of nonadherence to primary care follow-up among individuals aged 18-60years with a primary discharge diagnosis of asymptomatic hypertension in the ED. Data were obtained from a commercial claims database for January 2012-September 2015. A total of 84,929 individuals were included. Rate of nonadherence to primary care follow-up was determined for individuals billed for a primary discharge diagnosis of essential hypertension. Multivariate logistic regression was used to calculate adjusted odds ratios. The relationships between demographic and clinical variables with nonadherence to follow-up were assessed. Two-thirds of the study population did not adhere to follow-up within 30days of ED discharge. Risk factors for nonadherence included no history of recent visit with primary care (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.81-1.93) and multiple prior ED visits (OR 1.65; 95% CI 1.57-1.73). Protective characteristics included history of filling antihypertensive prescriptions in the last year (OR 0.42; 95% CI 0.40-0.43); or history of filling a 30-day antihypertensive prescription on day of diagnosis (OR 0.83; 95% CI 0.80-0.87). Individuals without a recent primary care visit or who visit the ED frequently are at higher risk of nonadherence to follow-up for hypertension, despite medical insurance. Insurance status may not overcome individual level barriers to follow-up.