Godley P, Pham H, Rohack J, Woodward B, Yokoyama K, Maue S K
Department of Pharmacy, Scott and White Hospital, 2401 South 31st Street, Temple, TX 76508, USA.
Am J Health Syst Pharm. 2001 Sep 15;58(18):1728-33. doi: 10.1093/ajhp/58.18.1728.
Hypertension management practices and patient health outcomes in a managed care setting were evaluated. Health-system pharmacists analyzed plan medical and pharmacy claims data for September 1, 1998, to August 31, 1999, to identify hypertensive enrollees (n = 23,316). Reviews of pharmacy claims and medical charts of a sample of hypertensive patients (n = 374) determined blood pressure control status, prevalence of cardiovascular risk factors, and comorbidities. The majority of patients treated for hypertension (66%) did not achieve blood pressure control. Analysis revealed a high prevalence of cardiovascular risk factors among hypertensive patients, with 92.2% of study patients having two or more risk factors. Reviews of 132,512 pharmacy claims revealed that one half of all prescribed therapies were for monotherapy, and 21% of hypertensive patients were prescribed combination therapy with two different agents. Data from a large managed care organization revealed that more than half of all hypertensive patients had inadequate blood pressure control. A quality improvement program for hypertension care that can improve patient health outcomes must educate patients and health care providers about the implications of the disease, identify patients with compelling comorbidities, evaluate pharmacologic regimens, and recommend therapeutic changes when necessary.
对管理式医疗环境中的高血压管理实践和患者健康结局进行了评估。卫生系统药剂师分析了1998年9月1日至1999年8月31日的计划医疗和药房理赔数据，以确定高血压参保者（n = 23,316）。对一部分高血压患者（n = 374）的药房理赔和病历进行审查，以确定血压控制状况、心血管危险因素的患病率和合并症。大多数接受高血压治疗的患者（66%）未实现血压控制。分析显示高血压患者中心血管危险因素的患病率很高，92.2%的研究患者有两种或更多危险因素。对132,512份药房理赔的审查显示，所有处方治疗中有一半是单一疗法，21%的高血压患者接受了两种不同药物的联合治疗。来自一个大型管理式医疗组织的数据显示，超过一半的高血压患者血压控制不佳。一个能够改善患者健康结局的高血压护理质量改进项目必须让患者和医疗服务提供者了解该疾病的影响，识别有严重合并症的患者，评估药物治疗方案，并在必要时建议治疗调整。
