In the post-visit survey, providers also answered questions regarding if and how the antihypertensive regimen was changed at the visit; medication intensification (as a dichotomous measure) was defined as providers adding or increasing a BP medication dose without stopping another medication or decreasing a dose [ 9].
Plausible explanations for our findings include the low engagement with the intervention, higher-than anticipated attrition rate, Hawthorne's effect or no effect of the intervention 15 18 Medication intensification is emerging as a process measure for quality improvement efforts among patients with diabetes mellitus; pharmacotherapy intensification is strongly linked to improved A1c, BP and LDL.
6 7 8 9 In addition, for all patients little evidence is available to guide the optimal time interval between measurement of elevated blood pressure and addition or dose escalation of antihypertensive medications ("medication intensification") or between medication intensification and follow-up measurement of blood pressure.
Transient elevations were defined as periods that contained only a single elevated measurement that subsequently normalized without any medication intensification and were excluded from the analysis.
Transient elevations were defined as isolated elevated measurements that subsequently normalized without any medication intensification and were excluded from the analysis.
During the last decade, several process measures tightly linked to patient outcomes in the treatment of diabetes have been identified (24), including medication intensification, lifestyle counseling (25), and encounter frequency (25– 25).
15 In our main study, 15 the main outcomes were measures of acceptable and optimal diabetes control. 2 3 The main outcome for this report is medication intensification, defined as a dose increase of an existing medication or the addition of a new class of medication for glucose, blood pressure and lipids control on any of the three most recent office visits.
Medication intensification for diabetes can have undesirable side effects (weight gain, hypoglycemia), which offset the benefits of glycemic control.
Medication intensification was defined as in the above study.
We also conducted sensitivity analyses that included variables for diabetes, cholesterol, and blood pressure medication intensification to ensure that intervention effects were not principally due to medication intensification.
