2006 HSR&D National Meeting Abstract
1047 — Impact of VA/Private Sector Co-Management on Blood Pressure Control and Guideline Concordant Therapy
Kaboli PJ (Iowa City VAMC)
Ishani A (Minneapolis VAMC)
Barnett MJ (Iowa City VAMC)
Henderson MS (Iowa City VAMC)
Wahls T (Iowa City VAMC)
Rosenthal GE (Iowa City VAMC)
VA primary care patients frequently receive care from providers outside VHA. The effects of “co-management” on patient outcomes are unknown. This study evaluated the impact of co-management on quality of care for veterans with hypertension.
The study included a convenience sample of patients with hypertension in primary care clinics at two VA Medical Centers and four community-based outpatient clinics. Consenting patients were interviewed before scheduled primary care visits and implicit review of medical records was performed by study physicians. The two primary outcomes of interest, based on VA hypertension guidelines, were achievement of blood pressure (BP) goal (<140/90 or <130/90 for patients with diabetes) and use of guideline-concordant hypertension therapy.
191 patients with hypertension were approached and 189 (99%) agreed to participate. Mean age of patients was 66 years, 97% male, and 92% white. 36% of patients identified a non-VA provider who co-managed their care. Co-managed patients had similar rates of comorbid illnesses compared to VA-managed patients, including hyperlipidemia (58% vs. 50%; p=.28) and diabetes (36% vs. 35%; p=.94), the two most common. Overall, 51% of patients were at BP goal, 58% were on guideline-concordant therapy, and 32% had both. Co-managed patients were as likely to attain their BP goal as VA-managed patients (51% vs. 51%, respectively; P=.99) and be on guideline-concordant therapy (63% vs. 56%, respectively; P=.35); mean number of BP medications was also similar (2.5 vs. 2.4; p=.85). Co-managed patients were more likely to be using thiazide diuretics (43% vs. 29%; p=.03) and less likely to use ACE inhibitors (43% vs. 61%; p=.02). No differences were observed between co-managed and VA-managed patients for use of beta blockers, (54% vs. 52%; p=.78) and calcium channel blockers (36% vs. 34%; p=.85).
In a primary care cohort with hypertension, co-managed patients had similar rates of BP control and guideline-concordant therapy, with some differences in anti-hypertensive use. Although co-management may make transfer of records and information more complex between providers and decrease continuity, it had no impact on quality in this one domain of care.
Given the prevalence of co-management, future work should evaluate its impact on quality in other domains of care.