Abstract 10125: Increasing Encounter Frequency, Physician Prescribing, or Patient Adherence - What Works Best for Controlling Blood Pressure?: Results From a New Simulation Model

Abstract

Background: Poor medication adherence is often cited as a major barrier to BP control, but other healthcare processes involved in BP management may be more easily controlled by physicians, such as encounter frequency and physician prescribing behavior. It is unclear how effective improvements in these factors would be without improving medication adherence.

Methods: We constructed a state-transition model to simulate the healthcare processes relevant in achieving BP control, including office visits, BP measurement, prescription of a new BP medication, variable medication effects, and medication adherence. We used data from nationally representative surveys, meta-analyses, and observational studies to derive model inputs for our base case scenario including probabilities for three modifiable parameters - encounter frequency, prescription rate, and adherence. We then modeled improvements of 10% and 50%, and an ideal scenario for each parameter. We introduced 1000 untreated patients with systolic BP (SBP) of 150 mmHg (repeated for SBP=170 mmHg) into the model, and report outcomes in terms of % control (SBP<140) at 12 months.

Results: In our base case scenario, 42% of patients with an SBP of 150 mmHg achieved BP control at 12 months. Isolated improvements in the physician-controlled parameters (encounter frequency and prescription rate) led to important improvements in BP control that were as large as or larger than those obtained by improving adherence (Table). Control rates at 12 months in the SBP=170 scenario were 20% (base case), 50% (ideal encounter frequency), 63% (ideal prescription rate), and 29% (ideal adherence).

Conclusions: While improving medication adherence would improve BP control, increasing encounter frequency and physicians’ prescribing of new medications for elevated BP would have a similar or greater impact, especially for persons with Stage II hypertension.