RT Journal Article
SR Electronic
T1 Physician follow-up and long-term use of evidence-based medication for patients with hypertension who were discharged from an emergency department: a prospective cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E151
OP E161
DO 10.9778/cmajo.20170119
VO 6
IS 2
A1 Clare L. Atzema
A1 Bing Yu
A1 Michael J. Schull
A1 Cynthia A. Jackevicius
A1 Noah M. Ivers
A1 Douglas S. Lee
A1 Paula Rochon
A1 Peter C. Austin
YR 2018
UL http://www.cmajopen.ca/content/6/2/E151.abstract
AB Background: More than 25% of the population has hypertension. The number of patients seeking care for hypertension in emergency departments has increased by more than 60% in the last decade, with less than 10% of these patients subsequently admitted to hospital. Managing physicians recommend early follow-up to patients who are discharged from the emergency department, but there is a paucity of literature assessing the impact or timing of follow-up on patient outcomes.Methods: Using a population-based cohort design, we included patients more than 65 years of age who were discharged from an Ontario emergency department with a primary diagnosis of hypertension between 2007 and 2014. We identified 2 cohorts: an incident cohort, and a cohort in which patients were on no more than 1 class of evidence-based antihypertensive medication at the time of presentation. Using logistic regression, we assessed the association of early follow-up care (within 7 d) and basic care (8–30 d), compared with no care within 30 days, on patient use of a new evidence-based antihypertensive medication 1 year later.Results: Our study included 2088 patients with a new diagnosis of hypertension (the first cohort), and 6420 patients in the second cohort. Of patients with new diagnoses, 48.2% and 30.2% obtained early and basic follow-up care, respectively, compared with 50.0% and 30.9% of patients in the second cohort. Compared with patients without follow-up care within 30 days, the adjusted odds of filling an evidence-based antihypertensive medication prescription 1 year later in the incident group were 2.36 (95% confidence interval [CI] 1.86–2.99) for those who received early care, and 2.00 (95% CI 1.55–2.58) for those who received basic care. The adjusted odds in the second cohort were 2.12 (95% CI 1.84–2.43) and 1.96 (95% CI 1.69–2.27), respectively.Interpretation: Early follow-up care after leaving an emergency department with a diagnosis of hypertension was associated with improved long-term use of evidence-based antihypertensive medication. As patients increasingly present to the emergency department for hypertension, a formal, timely follow-up care system could improve patient use of evidence-based antihypertensive medication.