Determining factors in the treatment choice of patients with hypertension with complications and secondary hypertension

Abstract

Purpose: The purpose of this article is to analyze the effects patients' socioeconomic characteristics, along with hospital size and location, had on the initial treatment choice for individuals with hypertension with complications and secondary hypertension.

Design/method/approach: The analysis uses retrospective data and binary logistic regression to analyze treatment choice determinants. Initial diagnostic and/or therapeutic procedures were categorized as invasive or non-invasive, which served as the dependent variable.

Findings: Uninsured people were more likely to get less expensive non-invasive treatment. Medicare patients were approximately twice as likely to receive an invasive procedure as individuals with private insurance, even after controlling for age and other socioeconomic characteristics. Minorities and males were also more likely to receive an invasive primary procedure. Significant treatment variations across States were also found.

Research limitations/implications: There were insufficient observations to look at variability within patients treated by a single physician. Future research could tie this information into a simultaneous equation system in order to determine whether patients who received one treatment type versus another were better off.

Practical implications: Finding that characteristics other than morbidity affect the type of treatment received indicates that public policy could improve care. Most important, the ability to pay, type of insurance, geographic location and race influence whether patients receive invasive or non-invasive treatment upon hospitalization for hypertension, indicating that policies prescribing treatment alternatives that remove non-medical issues from calculation may improve overall outcomes.

Originality/value: Comprehensive treatment-choice analyzes have been largely overlooked in the hypertension literature. Additionally, few studies analyze choice using data from such a diverse array of geographic areas and socio-economic strata.