Assessment of time to follow-up visits in newly-treated hypertensive patients using an electronic medical record database

Abstract

Objective:

Use of electronic medical record (EMR) data for evaluating healthcare processes and outcomes is relatively new. Using EMR data, this study evaluated the time from antihypertensive initiation to the first follow-up office visit controlling for adverse events (AEs) and other factors that could influence follow-up timing. Findings were compared to treatment guidelines which recommend monthly follow-up in treatment naive patients until blood pressure (BP) levels are controlled.

Research design and methods:

Treatment-naïve hypertensive adult patients in the General Electric Centricity EMR database (1996–2006) with a new antihypertensive prescription were evaluated. Time from treatment initiation to first office visit was identified and stratified by occurrence of AEs and therapy change. BP was assessed at 120 ± 30 days.

Results:

The mean ± SD time from first antihypertensive prescription (index date) to the first office visit was 96.2 ± 160.6 days; 38% returned within a month of treatment initiation. Controlling for baseline demographic and clinical characteristics, the adjusted time until first office visit was shorter for those with an AE and therapy change than for those with neither event (61 vs. 158 days). Of the patients with follow-up BP data for analysis (n = 27 875), more of those seen within a month of treatment initiation achieved BP goal at 120 days (<140/90 mmHg) than those who were not seen within a month (64.3 vs. 61.7% respectively; p < 0.001).

Conclusions:

This study demonstrates that EMR data can be used to assess quality measures which in turn can inform efforts to improve treatment outcomes. Specifically, this study evaluated mean time to first office visit after antihypertensive therapy initiation controlling for clinical factors that could influence office visit intervals based on data available in a national EMR dataset. A key limitation of this study is that the EMR may not represent patient care delivered by other providers, thus, use of antihypertensives, changes in therapy, and office visits may be underreported.

Key words:

• Hypertension
• Basic studies
• Cardiovascular pharmacology
• Health policy and outcome research

Transparency

Declaration of funding

Study funded in part by Novartis Pharmaceuticals Corporation. Role of sponsor: H.L. (as a Novartis employee) provided substantial contributions to the study design, acquisition of data and interpretation of results; H.L. also reviewed the manuscript for important intellectual content and granted submission approval of the version submitted for publication consideration.

Declaration of financial/other relationships

H.L. is an employee of Novartis Pharmaceuticals. D.B., M.M., C.M. have no relationships to disclose.

Acknowledgements

Authors would like to acknowledge Brian Oberg, MA, MBA, for his assistance with data analysis and Joe Biskupiak, PhD, MBA for his contributions into the study design and data interpretation. Mr Oberg was funded in part by the research grant provided by Novartis Pharmaceuticals, Corporation. Dr Biskupiak's contribution was not funded.

Components of this manuscript have not been previously published or presented.