Introduction
Potentially preventable hospitalizations (PPHs) for hypertension (HTN) is one indicator
of possible failed ambulatory care. Rates of PPHs for HTN have remained fairly level
since the late 1980s, which may reflect a lack of understanding of the drivers of
these hospitalizations. Anti-HTN medication non-adherence has been studied as a potential
risk factor for other cardiovascular disease outcomes but not for PPHs for HTN.
Methods
A cohort analysis was conducted during 2005–2012 of people with HTN enrolled in commercial
and employee health plans with claims in the MarketScan database. PPH for HTN was
defined according to specifications published by the Agency for Healthcare Research
and Quality. The proportion of days covered (PDC) algorithm was used to assess adherence
to antihypertensives. Crude- and multivariate-adjusted incident PPHs for HTN rates
were calculated, as well as third-party payments for selected PPH for HTN–related
expenses.
Results
During 9,344,528 person-years of follow-up (mean=3 years), 6,008 incident PPHs for
HTN were identified among 3,099,291 people. The crude rate for good adherence (PDC
≥80%) was 23.2 per 100,000 person-years compared with 102.6 per 100,000 person-years
for poor adherence (PDC <40%). Over the 8-year study, PPH for HTN–associated payments
equaled $41 million. Payments for those with poor adherence were four times higher
than for those with good adherence.
Conclusions
Poor anti-HTN medication adherence is strongly associated with PPHs for HTN. Improving
the percentage of people who achieve good medication adherence is one possible approach
to reducing the burden of PPHs for HTN in the U.S.
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Article info
Publication history
Published online: October 30, 2015
Identification
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Published by Elsevier Inc.
