| Statement of the problem. Hypertension is one of the most common and deadly chronic diseases in the United States today. Despite the fact that medications are readily available that can control high blood pressure, less than 25% of people who are diagnosed have adequate control. Nonadherence to prescribed antihypertensive medication regimens plays a major role in this avoidable morbidity and mortality. The primary goal of this dissertation is to assess understudied factors that may be related to adherence to antihypertensive medications.;Objectives. This study assessed the relationship between continuity of care, the mix of provider types involved in care, and morbidity burden on adherence to antihypertensive regimens.;Methods. This was a retrospective observational study using longitudinal medical and pharmaceutical claims data from the PharMetrics Integrated Outcomes Database. Patients included in this analysis had a medical claim with a diagnosis of hypertension and received at least one prescription for an antihypertensive medication. The relationship between adherence and the dependent and control variables was assessed using multivariate proportional odds models.;Results. A total of 2,432 patients were included in the analysis. There was no significant relationship detected between continuity of care and adherence. Compared to patients who only saw specialist providers, patients had higher odds of poor adherence if they only saw primary care providers (OR: 1.5, 95% CI: 1.0--2.2) or if they saw both types of providers (OR: 1.4, 95% CI: 1.1--1.9). Patients with the highest level of morbidity had decreased odds of having good adherence (OR: 0.7, 95% CI: 0.5--0.9).;Conclusions. The results suggest there is no relationship between continuity of care and adherence and patients with a primary care provider or a higher morbidity burden experience worse adherence. However, the results should be interpreted with caution. The measure of continuity of care used in this study does not assess the quality of the relationship between patient and provider. Additionally, the type of managed care services, extent of automatic refills, or racial and socioeconomic status of the patients are not included. These variables, if available, might help to explain the unexpected results observed in this study. |
