P-11: Effect of medication renewal access on blood pressure control

Alan J. Zillich; Barry L. Carter; Michael E. Ernst; Michael W. Kelly

doi:10.1016/S0895-7061(02)02362-2

Medications at the Family Medicine Clinic are renewed either by the physician during the office visit or by a clinical pharmacist via a telephone medication renewal service. This study evaluated the effect of medication renewal access on blood pressure control in an academic family medicine clinic. Age, gender, diagnosis of heart failure and/or diabetes were recorded for all patients seen at the Family Medicine Clinic with an ICD-9 code for hypertension during the year 2000. The frequency of hypertension related office visits and calls for antihypertensive medication renewals were recorded. Mean systolic and diastolic pressures and blood pressure control rates were calculated at the last clinic visit based on JNC-VI guidelines. ANOVA and stepwise logistic regression were performed to examine the frequency of office visits and the frequency of medication renewal requests on blood pressure control. Co-variables such as age, gender, diabetes and heart failure were included in the model. Of the 938 patients seen for hypertension, 368 were seen only one time. The medication renewal service was used at least once by 332 patients. The mean number of office visits was 2.6±2.2(±SD). Among those patients who used the telephone renewal service, the mean number of calls was 1.9±1.4. Overall, blood pressure control was 45.8%. Mean systolic pressure was 139±19.2 mm Hg while diastolic pressure was 81.8±11.0 mm Hg. The frequency of office visits had no significant effect on blood pressure control (n=938, p=0.48;CI 0.95-1.1). There was no difference in blood pressure control among those patients who used the telephone renewal service compared to those who did not use the service (p=0.86;CI 0.7-1.3). The number of office visits or renewal requests had no effect on systolic pressure (p=0.9, p=0.6, respectively) or diastolic pressure (p=0.14, p=0.6, respectively). Blood pressure control was no better for patients seeing a physician more frequently (p=0.61;CI 0.7-1.5). The lack of difference in blood pressure control with utilization of the medication renewal service or office visits may have several explanations. First, the renewal service provides increased access but the volume does not allow adequate time for patient education and counseling. Second, simply providing increased access to medications is necessary, but not sufficient, to insure good blood pressure control. The high blood pressure control rates in this clinic may have influenced the findings. Additional research should be conducted to determine if the observed higher blood pressure control rates may be due to the academic environment and/or the interdisciplinary practice with physicians, nurses, pharmacists, social workers and dieticians.

P-11: Effect of medication renewal access on blood pressure control

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