Project Title

Association between Home Blood Pressure Monitoring and Total Office Visits among Medicare Beneficiaries with self-reported High Blood Pressure.

Authors' Affiliations

Adekunle Oke, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Esther Adeniran, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN. Christian Nwabueze, Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN. Nathan Hale, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN.

Faculty Sponsor’s Department

Health Services Management & Policy

Type

Oral Competitive

Classification of First Author

Graduate Student-Doctoral

Project's Category

Health Services Delivery

Abstract Text

High blood pressure (BP) is the most significant risk factor for cardiovascular disease and a major contributor to chronic disease burden in the United States. Chronic conditions are the most common reason for office-based physician visits among adults, accounting for 37% of all visits. Home BP monitoring when combined with clinical support may help engagement with care and improve condition control. This study examines the extent to which home BP measurement is associated with total office visits among Medicare beneficiaries with self-reported high BP and the influence by other related factors.

The 2018 Medicare Current Beneficiary Survey (MCBS) was used in the study. The study population consists of Medicare beneficiaries (n=4,456) with self-reported high BP who had at least one total office visit in the year. Total office visits served as the outcome and were dichotomized to low (1-5 visits) and high (greater than 5 visits), while self-reported home BP measurement was the primary independent variable. Andersen’s conceptual framework was used to establish the co-variates [Predisposing factors: age, gender, race, education; Enabling factors: insurance plan (Medicare Advantage, MA), income, patients’ satisfaction (a. quality, b. information); Individual needs: smoking, BMI; Environment: region]. Bivariate analysis using a chi-square test for independence, unadjusted and adjusted logistic regression was conducted using SAS v 9.4.

Of the study population, 57.9% reported measuring blood pressure at home. Approximately 95.6% and 94.2% of beneficiaries were satisfied with the quality of care received and information about their symptoms respectively. Bivariate analysis showed a significant relationship between total office visits and home BP measurement (p<0.05). Unadjusted logistic regression results noted that those who reported home BP measurement had increased odds of high total office visits [uOR: 1.17 (1.02-1.33)]. This relationship was slightly increased in the adjusted analysis when accounting for other factors of interest [aOR:1.22 (1.06- 1.40)]. Those aged 65-74 years had reduced odds [aOR: 0.77 (0.61 -0.98)], females had increased odds [aOR: 1.38 (1.19 – 1.61)], and those with higher education had increased odds [aOR: 1.41 (1.14 -1.75)] of high total office visits. Those not enrolled in MA [aOR: 3.37 (2.31- 4.90)] and those who earn $25,000 or more [aOR: 1.23 (1.04 -1.45)] had increased odds of high total office visits. Those who have never smoked [aOR: 0.81 (0.69-0.94)] and those from the non-metro region [aOR: 0.65 (0.56-0.76)] had reduced odds of high total office visits.

We conclude that those who engage in home BP monitoring are more likely to have a high number of total office visits. The use of home BP monitoring could reflect the severity of high BP suggesting the need for regular follow-up and frequent use of services. Further studies that explore this association are recommended.

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Association between Home Blood Pressure Monitoring and Total Office Visits among Medicare Beneficiaries with self-reported High Blood Pressure.

High blood pressure (BP) is the most significant risk factor for cardiovascular disease and a major contributor to chronic disease burden in the United States. Chronic conditions are the most common reason for office-based physician visits among adults, accounting for 37% of all visits. Home BP monitoring when combined with clinical support may help engagement with care and improve condition control. This study examines the extent to which home BP measurement is associated with total office visits among Medicare beneficiaries with self-reported high BP and the influence by other related factors.

The 2018 Medicare Current Beneficiary Survey (MCBS) was used in the study. The study population consists of Medicare beneficiaries (n=4,456) with self-reported high BP who had at least one total office visit in the year. Total office visits served as the outcome and were dichotomized to low (1-5 visits) and high (greater than 5 visits), while self-reported home BP measurement was the primary independent variable. Andersen’s conceptual framework was used to establish the co-variates [Predisposing factors: age, gender, race, education; Enabling factors: insurance plan (Medicare Advantage, MA), income, patients’ satisfaction (a. quality, b. information); Individual needs: smoking, BMI; Environment: region]. Bivariate analysis using a chi-square test for independence, unadjusted and adjusted logistic regression was conducted using SAS v 9.4.

Of the study population, 57.9% reported measuring blood pressure at home. Approximately 95.6% and 94.2% of beneficiaries were satisfied with the quality of care received and information about their symptoms respectively. Bivariate analysis showed a significant relationship between total office visits and home BP measurement (p<0.05). Unadjusted logistic regression results noted that those who reported home BP measurement had increased odds of high total office visits [uOR: 1.17 (1.02-1.33)]. This relationship was slightly increased in the adjusted analysis when accounting for other factors of interest [aOR:1.22 (1.06- 1.40)]. Those aged 65-74 years had reduced odds [aOR: 0.77 (0.61 -0.98)], females had increased odds [aOR: 1.38 (1.19 – 1.61)], and those with higher education had increased odds [aOR: 1.41 (1.14 -1.75)] of high total office visits. Those not enrolled in MA [aOR: 3.37 (2.31- 4.90)] and those who earn $25,000 or more [aOR: 1.23 (1.04 -1.45)] had increased odds of high total office visits. Those who have never smoked [aOR: 0.81 (0.69-0.94)] and those from the non-metro region [aOR: 0.65 (0.56-0.76)] had reduced odds of high total office visits.

We conclude that those who engage in home BP monitoring are more likely to have a high number of total office visits. The use of home BP monitoring could reflect the severity of high BP suggesting the need for regular follow-up and frequent use of services. Further studies that explore this association are recommended.

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