Receipt of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers among Medicare beneficiaries with diabetes and hypertension

Objectives The proportion of patients with diabetes and hypertension receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEs/ARBs), is one of the quality measures for medication management employed by the Centers for Medicare and Medicaid Services to rate Medicare Part D plans. The objectives of this study were to determine the rate and predictors of receiving ACEs/ARBs in physician-office and outpatient visits made by Medicare beneficiaries with diabetes and hypertension. Methods The study population was Medicare beneficiaries with diabetes and hypertension from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey Outpatient Department, from 2007 to 2009. Predictors of receiving ACEs/ARBs were determined using bivariate and multivariate logistic regression analysis. Key findings Of the 6311 Medicare outpatient and physician-office visits with hypertension and diabetes, 40.7% patient visits were associated with receiving ACEs/ARBs. Bivariate analysis found that higher proportions of ACEs/ARBs were received during visits made to primary care physicians compared to visits to non-primary care physicians (48.39 compared with 32.56%; P < 0.05). Adjusted multivariate analyses indicated that ACEs/ ARBs were more likely to be received during visits to primary care physicians than visits to non-primary care physicians (odds ratio 1.96, 95% confidence interval 1.59-2.43), and ACEs/ARBs were more likely to be received during visits by patients residing in zip codes with a median household income in quartile 2 (US$ 32 794-40 626), compared to visits by patients residing in zip codes with a median household income in quartile 1 (<$ 32 793; odds ratio 1.45, 95% confidence interval 1.13-1.87). Conclusions Fewer than half of the patient visits were associated with receiving ACEs/ ARBs. Promoting evidence-based medicine and increasing access to primary care may have the potential to increase the rate of receiving ACEs/ARBs in this population.