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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HL092060-04
Application #
8209052
Study Section
Special Emphasis Panel (ZHL1-CSR-R (O1))
Program Officer
Ni, Hanyu
Project Start
2009-01-15
Project End
2013-12-31
Budget Start
2012-01-01
Budget End
2012-12-31
Support Year
4
Fiscal Year
2012
Total Cost
$137,700
Indirect Cost
$10,200
Name
University of Michigan Ann Arbor
Department
Pediatrics
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Yoon, Esther; McCool, Brigitte; Filipp, Stephanie et al. (2015) Pediatric Hypertension Specialists' Perspectives About Adolescent Hypertension Management: Implications for Primary Care Providers. Clin Pediatr (Phila) 54:551-6
Yoon, Esther Y; Cohn, Lisa; Freed, Gary et al. (2014) Use of antihypertensive medications and diagnostic tests among privately insured adolescents and young adults with primary versus secondary hypertension. J Adolesc Health 55:73-8
Yoon, Esther Y; Cohn, Lisa; Rocchini, Albert et al. (2012) Antihypertensive prescribing patterns for adolescents with primary hypertension. Pediatrics 129:e1-8
Lee, Joyce M; Wu, En-Ling; Tarini, Beth et al. (2011) Diagnosis of diabetes using hemoglobin A1c: should recommendations in adults be extrapolated to adolescents? J Pediatr 158:947-952.e1-3