ABSTRACT
Chagas disease is a chronic, systemic parasitic infection caused by the protozoan Trypanosoma cruzi. The primary mode of transmission to humans is by the Reduviid insect, endemic to South America. Recent migration of the vector has led to increased cases in the southern United States and has prompted increased surveillance and blood donation screening. It is unusual to diagnose and treat individuals with Chagas disease in the northern United States. This case describes an immigrant female from El Salvador that was informed she had Chagas disease from a blood bank screening. Confirmation and treatment of the disease were performed by her South Dakota primary care provider thus demonstrating the importance of identifying Chagas disease in the immigrant population in regions where Chagas disease infection is uncommon.
Subject(s)
Chagas Disease , Humans , Female , Chagas Disease/diagnosis , Chagas Disease/epidemiology , Chagas Disease/therapy , Chagas Disease/drug therapy , South Dakota , Trypanocidal Agents/therapeutic use , El Salvador , Adult , Emigrants and Immigrants , Nifurtimox/therapeutic useABSTRACT
Patient-centered medical home (PCMH) is a concept of a team of providers caring for a panel of patients with the goals to improve the quality of care while simultaneously decreasing the cost of that care. The clinical evidence that the PCMH approach achieves either goal is mixed. More studies are in progress that will provide more data.
Subject(s)
Chronic Disease/therapy , Patient Care Team/organization & administration , Patient-Centered Care , Disease Management , Humans , Models, Organizational , Patient Care Planning , Patient-Centered Care/methods , Patient-Centered Care/standards , Professional Role , Quality Improvement , United StatesABSTRACT
BACKGROUND: Despite publication and periodic updating of treatment guidelines, hypertension remains undertreated in the United States, and physicians underuse recommended drugs. METHODS: Hypertension treatment guidelines were summarized and posted in five places in a hospital-based primary care clinic staffed by internists and internal medicine residents. Costs and recommended doses of five commonly used antihypertensive drugs were included. The charts of all 253 patients seen during a four-month period with a diagnosis of hypertension were analyzed. Blood pressures and physician prescribing habits were compared at baseline and at 8, 12, and 16 months after posting the guidelines. RESULTS: The number of patients with blood pressures < 140/90 mm Hg increased from 41% to 58%, p = .001. Median (IQR) systolic pressure fell from 143 (119-167) to 137 (116-158) mm Hg, p < .0001 and diastolic pressure from 78 (65-91) to 77 (64-90) mm Hg, p = .0002. Physicians prescribed more recommended drugs, more total antihypertensive drugs, larger doses of hydrochlorothiazide and lisinopril, and more inexpensive drugs. The total cost of antihypertensive drugs per patient increased slightly. CONCLUSION: Regular exposure to clinical guidelines, presented in a practical and simple way, can change physician behavior and improve patient care.