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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3109 — Tolerance of Current Medication Regimes Predicts Whether Patients Have a Problem Adding New Blood Pressure Medications

Zikmund-Fisher BJ (VA Ann Arbor HSR&D Center of Excellence) , Hofer TP (VA Ann Arbor HSR&D Center of Excellence), Klamerus ML (VA Ann Arbor HSR&D Center of Excellence), Kerr EA (VA Ann Arbor HSR&D Center of Excellence)

When hypertensive patients present with elevated blood pressure (BP) levels, both provider and organizational factors can influence whether medication intensification is initiated. Health outcomes, however, also depend on patients' agreement with the intensified treatment plan. We sought to identify what behavioral and perceptual factors influence patients' willingness to accept new hypertension medications suggested by their primary care provider (PCP).

1,175 veterans with diabetes from 9 VA facilities in the Midwest were enrolled because they had an elevated triage BP level prior to a visit with one of 92 PCPs. Of these, 1,068 patients completed a comprehensive survey before and after the visit in which they provided ratings of how much of a problem they would have adding a new BP medication to their current medication regime if their PCP felt it was necessary. Other survey questions assessed various medication-related issues (e.g., concern about side effects, difficulty managing current medications) and BP-related factors (e.g., BP self-efficacy, concern over elevated BP levels).We used ordered logistic regression analyses to determine which medication and BP- related factors were associated with respondents' willingness to accept a new BP medication.

Four factors were associated with reporting a greater problem with adding a new BP medication: higher fear of medication side effects (p<0.001), greater difficulty managing current medications (p<0.001), greater perceived dependence on BP medications (p<0.001), and higher concern over elevated BP levels (p=0.05). Non-health competing demands, concern over cost issues, and the relative prioritization of BP control versus glucose control were not independently associated with perceived problem in adding new BP medications.

Diabetic patients' willingness to accept new BP medications appears to be primarily related to (a) their concern about medication side effects, (b) their difficulty managing their current medication regime, and (c) how much they perceive their health as dependent on BP medications. By contrast, measures of BP prioritization and self-efficacy showed little predictive power.

These results suggest that improving patients' ability to manage their current medications and their side-effects may increase patients' willingness to accept new treatment recommendations and potentially to improve downstream outcomes such as BP control.

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