J Korean Acad Community Health Nurs.  2014 Sep;25(3):159-169. 10.12799/jkachn.2014.25.3.159.

Effectiveness of Community-based Case Management for Patients with Hypertension

• Yun SN
• Lee IS
• Kim JH
• Ko Y

• KMID: 2292708
• DOI: http://doi.org/10.12799/jkachn.2014.25.3.159

Abstract

PURPOSE
The purpose of this study was to evaluate the effectiveness of case management for patients with hypertension on their health status and medical service utilization.
METHODS
This study was a secondary analysis of data collected for a larger study of chronic disease management in 2008 using the National Health Insurance Corporation database. A total of 12,944 patients who received case management for hypertension were included in this analysis. The subjects of case management were classified into subgroups, namely, over-use, under-use, and non-use groups according to the amount of medical service utilization. To compare the medical service utilization, a control group was selected randomly. The data were analyzed through descriptive statistics, McNemar test, and ANOVA.
RESULTS
All the subgroups displayed significant differences in blood pressure, self-management, social support, and their characteristics of medical service utilization. The total medical expense of the under-use and non-use groups increased after case management. However, there was no decrease in the medical expense of the over-use group.
CONCLUSION
This finding suggests that there is a need to re-examine why patients overuse medical services and to supplement specific strategies for encouraging appropriate medical service utilization, and enhancing case management efforts for the over-use group.

Keyword

Case management; Hypertension; Utilization; Health care; Health care costs

MeSH Terms

Blood Pressure
Case Management*
Chronic Disease
Delivery of Health Care
Health Care Costs
Humans
Hypertension*
National Health Programs
Self Care

Reference

1. Grover SA, Coupal L, Kaouache M, Lowensteyn I. Preventing cardiovascular disease among Canadian: What are the potential benefits of treating hypertension or dyslipidemia? Can J Cardiol. 2007; 23(6):467–473.

2. Kokubo Y, Kamide K, Okamura T, Watanabe M, Higashiyama A, Kawanishi K, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease in a Japanese urban cohort: The Suita study. Hypertension. 2008; 52(4):652–659. http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.118273.

3. Korea Centers for Disease Control and Prevention. Report No.: 11-135 1159-000027-10. National health statistics in 2011: Fifth 2nd year national health and nutrition examination (2011). Seoul: Ministry of Health and Welfare;2012.

4. Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: A cross-sectional study. BMJ Open. 2013; 3(8):e003423. http://dx.doi.org/10.1136/bmjopen-2013-003423.

5. National Health Insurance Corporation. Report No.: 11-B550928-000001-10. 2012 national health insurance statistical yearbook. Seoul: National Health Insurance Service and Health Insurance Review & Assessment Service;2013.

6. Yamamoto L, Lucey C. Case management "Within the Walls": A glimpse into the future. Crit Care Nurs Q. 2005; 28(2):162–178.

7. Kim YM, Shin EY, Lee KS. Effects of the case management program for the elderly with hypertension. J Korea Gerontol Soc. 2006; 26(3):477–492.

8. Patton K, Meyers J, Lewis BE. Enhancement of compliance among patients with hypertension. Am J Manag Care. 1997; 3(11):1693–1698.

9. Yim ES. Cost-benefit analysis of the case management for the elderly patients with hypertension [dissertation]. Seoul: Yonsei University;2009. p. 149.

10. Lu KY, Lin PL, Tzeng LC, Huang KY, Chang LC. Effectiveness of case management for community elderly with hypertension, diabetes mellitus, and hypercholesterolemia in Taiwan: A record review. Int J Nurs Stud. 2006; 43(8):1001–1010. http://dx.doi.org/10.1016/j.ijnurstu.2005.11.013.

11. So AY, Kim YM, Kim EY, Kim CY, Kim CH, Kim HG, et al. Effects of community-based case management program for clients with hypertension. J Korean Acad Nurs. 2008; 38(6):822–830. http://dx.doi.org/10.4040/jkan.2008.38.6.822.

12. Dally DL, Dahar W, Scott A, Roblin D, Khoury AT. The impact of a health education program targeting patients with high visit rates in a managed care organization. Am J Health Promot. 2002; 17(2):101–111.

13. Skaer TL, Sclar DA, Markowski DJ, Won JK. Effect of value-added utilities on prescription refill compliance and health care expenditures for hypertension. J Hum Hypertens. 1993; 7(5):515–518.

14. Yoo SH, Moon SH. Evaluating performance of finance stabilizing program for national health insurance. Korean Policy Stud Rev. 2006; 15(3):241–271.

15. Lee BY. The points and improvement plan of case management project of national health insurance corporation - centering on program of human resource development, education and training [master's thesis]. Deajeon: Daejeon University;2007. 106.

16. National Health Insurance Corporation. Job manual for proper utilization of medical care. Seoul: National Health Insurance Corporation;2007.

17. Korean Society of Hypertension. 2013 Hypertension treatment guidelines of the Korean society of hypertension. Committee on Establishment of Treatment Guidelines. Seoul: Korean Society of Hypertension;2013.

18. Friedman RH, Kazis LE, Jette A, Smith MB, Stollerman J, Torgerson J, et al. A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control. Am J Hypertens. 1996; 9(4 Pt 1):285–292.

19. Whelton PK, Appel LJ, Espeland MA, Appleqate WB, Ettinger WH, Kostis JB, et al. Tone collaborative research group. Sodium reduction and weight loss in the treatment of hypertension in older persons: A randomized controlled trial of nonpharmacologic interventions in the elderly(TONE). JAMA. 1998; 279(11):839–846.

20. Ginsberg GM, Viskoper JR, Fuchs Z, Drexler I, Lubin F, Berlin S, et al. Partial cost-benefit analysis of two different modes of nonpharmacological control of hypertension in the community. J Hum Hypertens. 1993; 7(6):593–597.

21. Kim CY, Kim YM, Kim EY, Kim CH, Kim HS, Kim HG, et al. Study on the application and expansion of pilot project of case management. Seoul: National Health Insurance Corporation;2004.

22. Drevenhorn E, Kjellgren KI, Bengtson A. Outcomes following a programme for lifestyle changes with people with hypertension. J Clin Nurs. 2007; 16(7B):144–151.

23. Choi IH. Changes of blood pressure and the performance of self-management of hypertension patients following the case-management [master's thesis]. Busan: Kosin University;2007. 19.

24. Lee WW. A study on the medical service use of high blood pressure patients through the case management program and on the effect of their self-management performing level [master's thesis]. Gyeongsan: Yeungnam University;2007. 73.

25. Ko IS, Kim CJ, Lee TW, Lee KJ, Kim ES, Ma HY, et al. Evaluation of government assisted visiting nursing services of health center in 2000. J Korean Acad Nurs. 2002; 32(3):344–354.

26. Yu SJ, Song MS, Lee YJ. The effects of self-efficacy promotion and education program on self-efficacy, self-care behavior, and blood pressure for elderly hypertensives. J Korean Acad Adult Nurs. 2001; 13(1):108–122.

27. Deng BH, Lui HW, Pan PC, Mau LW, Chiu HC. Cost-effectiveness of elderly health examination program: The example of hypertension screening. Kaohsiung J Med Sci. 2007; 23(1):17–24.

28. Williams A, Wold J. Nurses, cholesterol, and small work sites: Innovative community intervention comparisons. Fam Community Health. 2000; 23(3):59–75.

29. Lim SJ. The effects of case management for medicaid on healthcare utilization by the medicaid system. J Korean Acad Community Health Nurs. 2010; 21(4):375–385.

30. Lee HJ, Lee TJ, Jeon BY, Jung YI. Factors related to health care utilization in the poor and the general population. Korean J Health Econ Policy. 2009; 15(1):79–106.