TY - JOUR 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 SP - E151 LP - E161 DO - 10.9778/cmajo.20170119 VL - 6 IS - 2 AU - Clare L. Atzema AU - Bing Yu AU - Michael J. Schull AU - Cynthia A. Jackevicius AU - Noah M. Ivers AU - Douglas S. Lee AU - Paula Rochon AU - Peter C. Austin Y1 - 2018/04/01 UR - http://www.cmajopen.ca/content/6/2/E151.abstract N2 - 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. ER -