Medication patterns in coordinated hypertension care in Polish primary care

Background

Coordinated care may improve hypertension outcomes through more structured pharmacotherapy, but real-world evidence on prescribing patterns remains limited. In routine practice, treatment success depends not only on access to care, but also on treatment intensification and use of simplified regimens. Better understanding of medication patterns may therefore help explain why coordinated care translates into improved clinical control. We examined treatment patterns in patients managed in the Polish POZ PLUS model versus usual care.

Methods

We performed a retrospective case-control study using routine electronic health records from a primary care provider in Gdansk, Poland. Adults aged 40–75 years with ICD-10 I10 were included. The coordinated care group comprised 1,308 patients and the control group 623 patients. First and last recorded visits were analysed for number of drugs, fixed-dose combinations and antihypertensive drug classes. Statistical analyses were performed in R (version 4.2.3) using appropriate parametric or non-parametric tests and Fisher’s exact test for categorical variables.

Results

At baseline, the coordinated care group already had a higher treatment burden than controls, with a higher median number of drugs (2 vs 1, p < 0.0001) and more frequent use of fixed-dose combinations (23.9% vs 17.5%, p = 0.0014). At follow-up, the median number of drugs remained higher (2 vs 1, p < 0.0001), and fixed-dose combinations increased in both groups, reaching 28.2% in coordinated care and 21.5% in controls (within-group p = 0.0011 and p = 0.0039; between-group p < 0.0001). Use of beta-blockers, calcium channel blockers, thiazide/thiazide-like diuretics and ARBs was consistently more frequent in coordinated care.

Conclusions

Coordinated care was associated with more intensive and more structured antihypertensive pharmacotherapy. Better treatment organisation may be one pathway through which coordinated primary care supports improved blood pressure control.

Key messages

• Coordinated care was linked to more structured antihypertensive prescribing.

• Treatment organisation may be one mechanism behind improved hypertension outcomes.