Abstract 4137768: Evaluation of Therapeutic Intensification for Uncontrolled Hypertension Using Different Sources of Electronic Health Records

Background: Healthcare system level interventions to monitor therapeutic intensification for uncontrolled blood pressure (BP) may address potential therapeutic inertia, however, the best methods to evaluate therapeutic intensification using different sources of electronic health records are unknown. Question: To what extent do medication orders and pharmacy data provide comparable or distinct evaluations of therapeutic intensification? Methods: We identified adults with uncontrolled hypertension (systolic BP ≥140 or diastolic BP ≥90 mm Hg) in an outpatient encounter (index) from Kaiser Permanente Southern California in 2018. We included patients with new antihypertensive medication orders at the index encounter. We calculated therapeutic intensification score (TIS), a proportional measure of prescribed daily dose to maximum recommended daily dose of antihypertensive medications using two data sources: (1) medication orders including dose, directions for use, discontinuation order; (2) pharmacy fill data including strength, days’ supply, and quantity within 14 days after the index. Therapeutic intensification was determined by comparing the new dose at index and the previous dose [delta TIS (new dose – previous dose) >0]. Differences in TIS and the percentage of concordance using two methods were compared using descriptive statistics. Results: We included 75,935 patients with medication orders at the index encounter. Using medication order data, 84% increased the dose of antihypertensive medications with a median TIS (25 th , 75 th ) of 0.25 (0.13, 0.50). Among the total, 80% (n=61,485) filled their prescriptions. Among those who filled their prescriptions, 84% and 85% increased the dose using medication order and pharmacy data, respectively, with 95% concordance between the two methods. Mean (SD) differences in dose change was -0.06 (0.55) between the two methods ( p <0.001). Conclusion: A large portion of patients with uncontrolled BP failed to fill their new prescriptions, underscoring the value of utilizing medication order data to evaluate therapeutic intensification. For those who filled prescriptions, only minimal differences were observed between the evaluations using medication orders and pharmacy data.