Medicaid recipients with high blood pressure living in the southeast, minorities, and low income individuals are at increased risk of developing cardiovascular disease, according to data presented at the Seventeenth Annual Scientific Meeting of the American Society of Hypertension.
Investigators said their research confirms that patients in high-risk categories are not efficiently communicating with their healthcare providers, which leads to a reduction in favorable health outcomes.
"The data confirm the impression that hypertensive Medicaid patients are at higher risk for major cardiovascular disease leading to hospital admissions," said Brent Egan, MD, Medical University of South Carolina. "Patients are not communicating efficiently with their healthcare providers leading to a reduction in favorable health outcomes.
"Hypertensive Medicaid beneficiaries living in South Carolina are disproportionately African-American, and by definition, low income," he said. "Among these high-risk groups, development of disease was more frequent and occurred 10-20 years earlier compared to the general U.S. population."
To better characterize health-outcomes in this high-risk population, researchers obtained data from billing records on hospitalization and prescription medication use after hospital discharge. The data were examined in collaboration with the Carolina Medical Review of 26,591 continuously enrolled hypertensive beneficiaries in the South Carolina Medicaid program.
The researchers found that hospital readmission rates for hypertensive Medicaid patients were relatively high over the two-year observation period following hospital discharge. Many of the patients have diabetes as a comorbitity (35%), which leads to frequent hospitalization. However, after hospital discharge, the majority of patients did not fill a prescription for medical therapy, which has been proven to improve outcomes and reduce hospital readmissions.
"The high admission and readmission rates are associated with sub-optimal use of prescribed medications," said Dr. Egan. "Research suggests that the majority of Medicaid patients fail to obtain proper guidance about prescriptions and the importance of maintaining medical therapy."
The lack of education about treatment does not reflect a policy limitation, since prescriptions of hypertensive Medicaid beneficiaries are not restricted.
"This data suggests an opportunity of professional educational programs aimed at increasing the efficacy of the patient-provider interaction," Dr. Egan said. "This underscores the importance of the American Society of Hypertension's affiliated ASH Specialists Program and the designated Clinical Hypertension Specialists who work at the regional and community level to provide consulting to physicians and to enhance education, research and advocacy."
There are currently 786 specialists in Clinical Hypertension in the United States. The American Society of Hypertension established the program in 1998 to identify and recognize those physicians with expert knowledge and skill in the management of clinical hypertension and related cardiovascular disease.
"Ensuring proper prescribing behavior and implementing strategies for enhancing patient adherence could increase favorable health and economic implications for Medicaid beneficiaries," Dr. Egan noted. "Improved outcomes may also help reduce racial disparities in hypertension-related complications."
The American Society of Hypertension (ASH) is the largest US organization devoted exclusively to hypertension and related cardiovascular diseases. ASH is committed to alerting physicians, allied health professions and the public about new medical options, facts, research findings and treatment choices designed to reduce the risk of cardiovascular disease.
