Date of Award

Winter 2009

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Karen Kalowicz

Committee Member

Jacqueline Sharpe

Committee Member

Qi Zhang


This study examined the relative utility of the enhanced Health Belief Model as compared to the proposed Pharmaceutical Acquisition Model for Medicare Elders (PAMME) in describing antihypertensive acquisition with usage intentions for Medicare elders (65 years or older) in Southeastern Virginia. Data collection included record reviews to identify hypertensive Medicare elders. Consenting Medicare elders were randomly selected for invitation, with consenting Medicare elders contacted by telephone or in-person interviews. The survey instrument utilized open and closed ended questions. The target population for this study is Southeastern Virginia Medicare elders enrolled in a Part D plan and prescribed at least one antihypertensive. This study employed a quasi-experimental, retrospective, mixed methods design. Acombination of primary and secondary data was obtained through telephone, face-to-face interviews and administrative record review. This study retrospectively examined antihypertensive acquisition experiences of Southeastern Virginia's Medicare elders, to explore how the Medicare Modernization Act of 2003 affected out-of-pocket costs and antihypertensive acquisitions. Analyses employed aggregate-based information to test the research hypotheses. Statistical analysis was conducted with SPSS Version 16. The majority (94 percent) of Medicare elders were able to legally acquire their antihypertensives. When comparing the enhanced Health Belief Model (HBM) with the Pharmaceutical Acquisition Model for Medicare Elderly (PAMME) the HBM has 95.5 while 96.2 indicating slightly increased prediction with the added constructs of Medication Adherence and Consumer Choice Theory. This study confirms other research findings regarding Medicare elders' beliefs about generics with the majority (71.6 percent) who believe that the generic works just as well as the name brand. The complexity of antihypertensive acquisition decisions and beliefs about hypertension continue to provide a challenge for researchers. While this study has furthered our understanding of what factors influence legal antihypertensive acquisitions, much research remains to be conducted to fully comprehend the multidimensional constructs of hypertension and antihypertensives.