Provider factors influencing prescriptions of recommended antihypertensive medications among patients with diabetes and hypertension

Abstract

Objective: Managing hypertension to prevent complications in patients with diabetes requires appropriate pharmacotherapy. This study aimed to analyze healthcare provider factors influencing prescriptions of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) as the first-line therapy in managing hypertension among patients with diabetes in primary care. Materials: This study used National Health Insurance Claims Data in Korea. Methods: We calculated the prescription rate of angiotensin-converting enzyme inhibitors (ACE inhibitors) or ARBs by dividing the number of patients prescribed an ACE inhibitor or an ARB by the number of patients with diabetes prescribed hypoglycemic agents and antihypertensive agents. We performed a logistic regression to investigate the factors influencing the prescription rate of ACE inhibitors or ARBs. Results: The mean prescription rate of ACE inhibitors or ARBs was 69.8%. The prescription rate of ACE inhibitors or ARBs decreased with increasing physician and patient age. The rate was higher for male patients than for females. The rate was higher in institutions with a greater number of physicians and among internists than among general practitioners, surgery-related and internal medicine-related specialists. The rate was significantly influenced by the mean monthly number of patients with hypertension per medical institution, the number of physicians per medical institution, and the physician's age and specialty. Conclusion: The age and specialty of the prescribing physician influenced the use of ACE inhibitors or ARBs in patients with diabetes and hypertension in primary care. Efforts are needed to promote information exchange among physicians and the appropriate prescriptions of antihypertensive agents in patients with diabetes and hypertension in primary care.