RÉSUMÉ
This study examined achievement of blood pressure (BP) goals, changes in antihypertensive therapy and reasons for these changes among adults with hypertension initiating angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or calcium channel blockers (CCBs). Claims data were examined for changes to medication regimens. Patient charts for 501 patients provided BP levels and reasons for changing medications. BP goal achievement was highest for initiators of ARBs (81.4%), compared with ACEIs (75.5%; P=NS) and CCBs (68.9%; P<0.01). Changes in antihypertensive therapy were least likely among ARB recipients (59.9%) compared with ACEIs (71.86%; P=0.02) and CCBs (74.85%; P<0.01). Failure to achieve BP goals was the most common reason for change in therapy (ARB, 32.9%; ACEI, 42.5%, P=NS; CCB, 47.9%, P<0.01). Although most patients achieved target BP goals, many required changes in treatment regimens. Initial choice of antihypertensive therapy may mitigate changes in therapies and better achieve BP goals.
Sujet(s)
Antihypertenseurs/usage thérapeutique , Pression sanguine/effets des médicaments et des substances chimiques , Substitution de médicament , Hypertension artérielle/traitement médicamenteux , Assurance prestations pharmaceutiques , Programmes de gestion intégrée des soins de santé , Types de pratiques des médecins , Adulte , Sujet âgé , Antagonistes du récepteur de type 1 de l'angiotensine-II/usage thérapeutique , Inhibiteurs de l'enzyme de conversion de l'angiotensine/usage thérapeutique , Inhibiteurs des canaux calciques/usage thérapeutique , Ordonnances médicamenteuses , Femelle , Adhésion aux directives , Humains , Hypertension artérielle/physiopathologie , Assurance prestations pharmaceutiques/statistiques et données numériques , Modèles logistiques , Mâle , Programmes de gestion intégrée des soins de santé/statistiques et données numériques , Adulte d'âge moyen , Odds ratio , Guides de bonnes pratiques cliniques comme sujet , Types de pratiques des médecins/statistiques et données numériques , Études rétrospectives , Appréciation des risques , Facteurs de risque , Facteurs temps , Résultat thérapeutique , États-UnisRÉSUMÉ
BACKGROUND: Depression is under-diagnosed and under-treated in the primary care sector. The purpose of this study was to determine the association between self-reported indications of depression by community-dwelling elderly enrollees in a managed care organization and clinical detection of depression by primary care clinicians. METHODS: This was a 2-year cohort study of elderly people (n = 3410) who responded to the Geriatric Depression Scale (GDS) at the midpoint of the study period. A broad measure of clinical detection was used consisting of one or more of three indicators: diagnosis of depression, visit to a mental health specialist, or antidepressant medication treatment. RESULTS: Approximately half of the community-based elderly people with self-reported indications of depression (GDS > or = 11) did not have documentation of clinical detection of depression by health providers. Physician recognition of depression tended to increase with the severity of enrollees' self-reported feelings of depression. Men 65-74 years old and those > or = 85 years old were at highest risk for under-detection of depression by primary care providers. CONCLUSIONS: Clinical detection of depression of elderly people living in the community continues to be a problem. The implications of failure to recognize the possibility of depression among elderly White men suggest a serious public health problem.
