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Title: Evidence-based prescribing patterns for hypertension among insured patients in Hawaiʻi 
Author: Kretzer, Kikikipa
Date: 2005
Abstract: Problem: There is little evidence to determine if practice patterns for anti hypertension medications adhere to Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JCN 7) guidelines in individual populations, such as the Hawai'i population, either for first use or over time. Purpose: To investigate for a large insured population in Hawai'i the use of antihypertensive agents, to look at prescribing patterns of antihypertensive drug classes initially used and across the first year of use, and to compare results to previously-published studies. Design: This was a non-concurrent longitudinal study. Sample: The sample consisted of 98,131 members prescribed at least one antihypertensive medication between the years 1999-2002. Methods and Analysis: Adherence with antihypertensive medications was measured using pharmaceutical claims and was based on a medication possession ratio (i.e., the percentage of days with a prescribed medication). A ratio of 0.8 or greater was considered adherent. Adherence was examined for 9 drug classes used by members who were classified into four disease categories (members with hypertension (HTN) alone, members with HTN and diabetes mellitus (DM), members with HTN and congestive heart failure (CHF), and members with HTN, CHF and OM). Factors affecting adherence were analyzed using multivariable logistic regression analysis. ,Results are expressed as odds ratios (O.R.s) with 95% confidence intervals. Findings: Contrary to JNC 7 recommendations ACE Inhibitors (ACEls) and calcium channel blockers (CCBs) were used most often for all disease categories both for initial use and over time. Thiazide diuretics were used less than 11 % of the time. Conclusions & Recommendations: Prescribing patterns were inconsistent with JNC 7 guidelines and confirm results of previously-published studies. There was switching of prescriptions and high variability in use beyond the initial prescription. Non first-line drugs were used across all disease categories .
Description: Thesis (M.S.)--University of Hawaii at Manoa, 2005. Includes bibliographical references (leaves 29-31). x, 31 leaves, bound 29 cm
URI: http://hdl.handle.net/10125/20427
Rights: All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Keywords: Hypertension -- Chemotherapy -- Hawaii, Drugs -- Prescribing -- Hawaii

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