2018 Big Sky GeoCon

Hypertension is a major risk factor for stroke and heart disease. Controlling high blood pressure (HBP) through blood pressure medication adherence (BPMA) is a key component in the prevention of heart disease and stroke. The objective was to document geographic disparities, identify and assess gaps in pharmacy services, and inform programs and policies related to BPMA.

To enhance GIS capacity to address BPMA in Montana, the Montana Department of Public Health and Human Services (DPHHS) Cardiovascular Health Program was awarded an advanced GIS training through CDC’s Division for Heart Disease and Stroke Prevention, in collaboration with the National Association of Chronic Disease Directors and Rice University. Montana DPHHS collaborated with Montana Medicaid to obtain claims data from 2010-2016 on dual eligible beneficiaries 18-64 years with >2 claims for prescribed hypertension medication. BPMA was defined as proportion of days covered (PDC)>180 days, and beneficiaries with PDC <80% were considered non-adherent. Three data sources were aggregated to identify Montana pharmacies: University of Montana Skaggs School or Pharmacy, Department of Labor and Industry, and Centers of Medicare and Medicaid Services National Plan and Provider Enumeration System. ArcGIS 10.2.1 and ArcGIS On-line were used to geocode pharmacies, map blood pressure non-adherence, and calculate distance to pharmacies.

Hypertension prevalence varies across health regions (26%-34%) and at the block level for two larger cities (24%-37%). Maps illustrating blood pressure medication non-adherence showed geographic disparities among counties encompassing American Indian reservations regardless of beneficiary type. Higher BP non-adherence rates were seen among Medicaid beneficiaries compared to Medicare beneficiaries. These maps assisted in identifying and assessing pharmacy services to focus project implementation.

By identifying geographical areas with blood pressure medication non-adherence, we recognized high priority areas to focus limited resources, identified new partners, and helped bridge gaps between public health and community pharmacies.