Hypertension is an increasingly common chronic condition in children and adolescents that may be managed by primary care physicians and/or subspecialists. Prescription of safe and cost-effective antihypertensive medications to children and adolescents with hypertension is essential to ensuring the best possible clinical and economic outcomes. However, there are no clear evidence-based guidelines to direct pharmacologic management of hypertension in children and adolescents. The proposed project aims to identify which physicians prescribe antihypertensive medications to children and adolescents;explore the factors that influence antihypertensive medication choice;examine the generalist-subspecialist interface in the co- management of hypertension in children and adolescents;and develop recommendations for potential co- management models for different combinations of clinicians of various medical specialties involved in the management of children and adolescents with hypertension. The project is organized into 4 phases: (1) Analysis of administrative data to provide an overview of antihypertensive medication utilization and description of physicians who prescribe antihypertensives to children and adolescents with hypertension;(2) Physician interviews to identify factors influencing physician pharmacologic management decisions and the roles and expectations of generalists and subspecialists in co-management of children with hypertension;(3) Physician surveys to further explore factors associated with physician pharmacologic management decisions and the roles and expectations of generalists and subspecialists in co-management of children with hypertension;and (4) Development of recommendations for potential models of co-management of children and adolescents with hypertension. Career development activities will include formal training in statistical analysis of clinical data, qualitative methods, survey methods, and clinical decision-making, with guidance and direction from a panel of dedicated and experienced mentors.
Because antihypertensive medications are often expensive and long-term therapies, a greater understanding of the existing organization and delivery of health care services to children and adolescents is an essential step toward prescribing safe and cost-effective antihypertensive medications to children and adolescents with hypertension.
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