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Difference of antihypertensive prescribing between office- and hospital-based clinics in Taiwan

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Abstract

Background The geographical location and medical facility may affect the pattern of antihypertensive prescriptions. Information regarding the correlation between the prescription and health care faculties in different geographical locations was lacking. Objective The aim of this study was to compare differences in the prescribing of antihypertensives between hospital-based clinics (hospital arm) and office-based clinics (office arm) in different geographical locations in Taiwan. Method We collected data from the National Health Insurance database of Taiwan to carry out a population-based, retrospective cohort analysis of 3,218,794 patients newly diagnosed with hypertension in the period January 1, 1997 to December 31, 2004. Eligible participants were classified into either of two groups based on the level of health care faculty: hospital arm and office arm. The covariates composed of age, gender, antihypertensive regimens, urbanization status, comorbidity, and Charlson comorbidity index. Results There were 2,028,784 cases (63.0 %) for the hospital arm and 1,190,010 (37 %) for the office arm. In the hospital-based arm, there were 168,933 (8.3 %) patients diagnosed with diabetes mellitus, 166,110 (8.2 %) patients diagnosed with coronary artery disease, 147,465 (7.3 %) patients diagnosed with cerebrovascular accident, 86,866 (4.3 %) patients diagnosed with chronic kidney disease, 74,525 (3.7 %) patients diagnosed with benign prostatic hyperplasia, 55,517 (2.7 %) patients diagnosed with congestive heart failure. The all comorbidities in the hospital arm had significantly higher proportions than those in the office arm (p < 0.001). The Charlson comorbidity index in the hospital arm was higher than that in the office arm (p < 0.001). Physicians who practiced in the office arm prescribed polytherapy less often than those in the hospital arm (OR = 0.68, 95 % CI: 0.67–0.68). For overall urbanization status, the adjusted OR of polytherapy prescriptions in the aging city (OR = 1.08, 95 % CI: 1.05–1.12) was higher than other type cities. The highest urbanization-specific OR of polytherapy prescriptions was observed for highly urbanized city in the hospital arm (OR = 1.20, 95 % CI: 1.18–1.23) and aging city in the office arm (OR = 1.42, 95 % CI: 1.21–1.67). In the both arm, patients with lower CCI showed decreased risk of polytherapy prescription. Conclusion The antihypertensive prescriptions in the clinical practices were different between the hospital arm and the office arm in the different health care, comorbidity, and urbanization status. During the study period, the proportion of antihypertensive polytherapy had declined.

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Abbreviations

ATC:

Anatomic therapeutic chemical

ACEIs:

Angiotensin converting enzyme inhibitors

ARBs:

Angiotensin II receptor blockers

ABs:

α-blockers

BBs:

β-blockers

BP:

Blood pressure

CCBs:

Calcium channel blockers

CI:

Confidence interval

CCI:

Charlson comorbidity index

HTN:

Hypertension

ICD-9-CM:

International classification of disease, ninth revision, clinical modification

JNC:

The Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure

NHI:

National Health Insurance

NAHST:

Nutrition and Health Survey in Taiwan

OR:

Odds ratio

SBP/DBP:

Systolic blood pressure/diastolic blood pressure

TwSHHH:

The Taiwanese Survey on hypertension, hyperglycemia, and hyperlipidemia

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Acknowledgments

We would like to thank the National Council of Science and Tri-Service General Hospital. This study is based in part on data from the NHIRD provided by the Bureau of National Health Insurance, Department of Health, and managed by National Health Research Institutes. The interpretation and conclusions contained in this report do not represent those of Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.

Funding

This study was supported by the National Council of Science and Tri-Service General Hospital.

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None.

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Authors and Affiliations

  1. Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Number 325, Section 2, Cheng-Gong Road, Neihu, 114, Taipei, Taiwan

    Wei-Liang Chen, Tung-Wei Kao, Chung-Ching Wang, Yaw-Wen Chang, Li-Wei Wu & Chih-Chieh Chou

  2. Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan

    Mark L. Wahlqvist

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  1. Wei-Liang Chen
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Correspondence to Chih-Chieh Chou.

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Chen, WL., Kao, TW., Wang, CC. et al. Difference of antihypertensive prescribing between office- and hospital-based clinics in Taiwan. Int J Clin Pharm 34, 710–718 (2012). https://doi.org/10.1007/s11096-012-9664-9

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