Association between the size of healthcare facilities and the intensity of hypertension therapy: a cross-sectional comparison of prescription data from insurance claims data

Abstract

Hypertension is a heterogeneous disease for which role sharing in treatment between specialized facilities and small clinics is needed for efficient healthcare provision. However, the Japanese healthcare system has a “free access” attribute; therefore, nobody can control treatment resource allocation. We aimed to describe the current situation of role sharing by comparing antihypertensive therapies among different types of medical facilities. We analyzed 1% sampled Japanese medical insurance claims data related to outpatient care as of October 2014. We divided the target patients into four groups according to the size of the facilities that issued the insurance claim for them. Among these groups, we compared the number of antihypertensive drugs and proportion of difficult-to-treat hypertensive cases and performed a stratified analysis. The proportion of patients with hypertension and diabetes mellitus receiving renin-angiotensin-aldosterone system inhibitors (RAASis) as the first-choice drug was also compared. We identified 3465, 1797, 2323, and 34,734 claims issued from large, medium-sized, small hospitals, and clinics, respectively. The mean number of hypertensive drugs was 1.96, 1.87, 1.81, and 1.69, respectively, and the proportion of difficult-to-treat hypertensive cases was 18.9, 17.0, 14.3, and 12.0%, respectively, with both showing significant differences. Stratified analysis showed similar results. The proportion of patients with hypertension and diabetes mellitus receiving RAASis as the first-choice drug was higher in large hospitals than in clinics. In conclusion, facility size is positively associated with the number of antihypertensive drugs and proportions of difficult-to-treat hypertensive cases. This finding describes the current role sharing situation of hypertension therapy in the Japanese healthcare system with a “free-access” attribute.

Use of fixed-dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia

“…A study in Japan showed an association between the size of health care facilities and the intensity of hypertension therapy. Physicians in larger facilities prescribed higher number of AHT drug classes compared with those working in smaller facilities and clinics [ 15 ]. Beside these factors, some statutory health insurance companies in Germany still select payment of single rather than fixed-dose combinations, referring to the guidelines on General Practitioner Risk Advice on Cardiovascular Prevention of the German College of General Practitioners and Family Physicians (DEGAM, valid until 31 December 2021) which have not recommended FDCs but rather free combinations [ 16 ].…”

Calcium channel blocker in patients with chronic kidney disease

“…The medications can be effective in reducing urinary protein, slowing the renal function aggravation, and preventing various events including CVD. More than one drug may be required in patients with treatment-resistant hypertension [ 7 , 15 ], and this is especially true in patients with CKD. The selection of an appropriate antihypertensive regimen for CKD patients is discussed in this review.…”