Relationship between outpatient visit frequency and hypertension control: a 9-year occupational cohort study

Abstract

The purpose of this study was to investigate the relationship between the frequency of outpatient visits and hypertension control as determined from health insurance records. This 9-year cohort study in Japan was based on 518 participants with hypertension who underwent health checkups in 2004. Participants were aged 35-56 years and none had a history of cardiovascular or cerebrovascular disease. All were covered by the same employee health insurer. Mean annual outpatient visit days at a hospital/clinic during the 9-year period were classified within four quartiles (Q1, Q2, Q3, Q4). Uncontrolled hypertension was defined as a systolic blood pressure (BP) ⩾140 mm Hg and a diastolic BP ⩾90 mm Hg. Logistic regression analysis was used to estimate the multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the prevalence of uncontrolled hypertension in groups Q1, Q2 and Q3 vs. Q4. The median (25th-75th percentile) annual outpatient visit days was 9.4 (4.0-15.5). Uncontrolled hypertension was observed in 62.4% of the participants in 2013. The multivariable-adjusted ORs and 95% CIs for uncontrolled hypertension in Q1, Q2 and Q3 vs. Q4 were 4.03 (2.28-7.12), 1.67 (0.99-2.81) and 1.44 (0.86-2.41), respectively. Uncontrolled hypertension increased significantly as the number of outpatient visits decreased (P for trend <0.001). This tendency was maintained when participants taking antihypertensive agents at baseline were excluded. Our study showed an inverse relationship between outpatient visit frequency and uncontrolled hypertension.

University hospitals, general hospitals, private clinics: Place-based differences in patient characteristics and outcomes of AF—A SAKURA AF Registry Substudy

“…Another explanation for exhibiting the prognostic differences may be due to the frequency of outpatient visits among the types of facility. Generally, the frequency of outpatient visits is lowest in the larger hospitals in Japan [16], and this was in fact evident in our study cohort. The more frequent outpatient visits that occur at clinics tend to improve patients' awareness, treatment satisfaction, and medication adherence, and comorbidities such as hypertension, diabetes, and dyslipidemia come under better control [16].…”

Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries

“…Healthcare professionals were more likely to detect previously undiagnosed co-occurring conditions [25,26], such as hypertension, angina, and arthritis in this particular study. More comorbidities and increased frequency of healthcare visits were likely associated with a greater tendency for routinely taken blood pressure measurements to indicate hypertension, and for patients to selfreport "chest pains" and arthritis symptoms [27][28][29]. For other conditions such as CLD and depression that require non-routine checks and are less self-reported, they may still be undiagnosed despite more patients having more comorbidities and more frequent healthcare visits [30][31][32][33].…”

Clinical Outcomes of Off-Label Underdosing of Direct Oral Anticoagulants After Ablation for Atrial Fibrillation

“…26,27) Data pertaining to the clinical outcomes of underdosing of DOACs are lacking, especially for patients at low risk for stroke and for patients who are of low body weight, like Japanese. Furthermore, with a Japanese social insurance system that provides for periodic physical examinations, and thus risk factors linked to adverse clinical events are managed, it also provides for such interventions as administration of antihypertensive, lipid-and glucoselowering medications and thus may increase patients' awareness of their status and therefore lower their risks for stroke and bleeding, 28) with this system, which is a universal health insurance system, differing from that of other countries. In fact, there are reports of similar incidences of ischemic stroke between off-label under-dose DOAC users in Japan, even in those who did not undergo AF ablation, and appropriate standard-dose users.…”