Dissertations & Theses (Open Access)

Date of Award

Spring 5-2019

Degree Name

Master of Public Health (MPH)

Advisor(s)

Melissa Valerio, Phd

Second Advisor

John Cornell, Phd

Third Advisor

Trudy Krause, Phd

Abstract

Background: One strategy to decrease uncontrolled hypertension is to increase follow-up with primary care after diagnosis of asymptomatic hypertension in the Emergency Department (ED). To improve such interventions, this study identified risk factors of nonadherence among individuals 18-60 years old with a diagnosis of asymptomatic hypertension in the ED and access to care. Methods: Data was obtained from the IBM® MarketScan® Commercial Database between January 2012 and September 2015. Rates of non-adherence to follow-up was determined for individuals discharged from the ED with a primary diagnosis of essential hypertension. Multivariate logistic regression was used to calculate adjusted odds ratios. Demographic and structural variables were evaluated to determine their relationship with non-adherence to follow-up. Results: Two-thirds of the study population did not adhere to follow-up within 30 days. Risk factors for non-adherence included no history of recent visit with primary care (OR=1.87; 95% 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 an anti-hypertensive prescription in last year (OR=0.42; 95% CI=0.40-0.43); or history of filling a 30-day anti-hypertensive prescription on day of index event (OR=0.83; 95% CI=0.80-0.87). Conclusion: Individuals who have not visited primary care or who are at the ED for the third time in 12 months are more likely to be non-adherent to follow-up. History of filling a 30-day anti-hypertensive prescription within one day of index event or in prior 12 months is associated with increased adherence to follow-up and should be further explored as a strategy for encouraging follow-up in this population.

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