Is Home Blood Pressure Monitoring Effective at Controlling Hypertension in African American Patients? A Clin-IQ.

African Americans are disproportionately affected by hypertension, a modifiable contributor to multiple chronic diseases and premature death. Primary care physicians play an important role in hypertension control. Home blood pressure monitoring (HBPM) is an evidence-based method for confirming diagnosis and monitoring hypertension over time. Some studies have found that HBPM may lead to clinically relevant reductions in blood pressure when combined with additional interventions, but few studies have focused specifically on African American populations. Evidence of effectiveness could increase clinical recommendation of HBPM. This clinical inquiry examined whether HBPM improves blood pressure control in African Americans with uncontrolled hypertension. Reviewed studies included 4 randomized controlled trials and 2 comparative research studies. Because these studies often were coupled with various co-interventions, ascertaining the independent effects of HBPM was difficult. When examining reviews of HBPM without a co-intervention and conducted independent of race, HBPM alone was insufficient to achieve long-term changes in hypertension control. More research focused on African Americans, with use of control groups, is needed to determine the true role for HBPM in controlling hypertension in this at-risk patient population.

Seroprevalence of COVID-19 IgG Antibody in Resident and Fellow Physicians in Milwaukee, Wisconsin: Analysis of a Cross-Sectional Survey.

PURPOSE: Medical trainees are likely at differential risk of exposure to COVID-19 per respective clinical activity. We sought to determine the seroprevalence of COVID-19 antibody (Ab) among resident and fellow physicians with varying degrees of exposure to COVID-19. METHODS: A cross-sectional study of Milwaukee-based resident and fellow physicians, encompassing December 2019-June 2020, was conducted. Relevant variables of interest were ascertained by survey and payroll data, and Abbott ARCHITECT Ab test (index cut-off of ≥1.4) was performed. Descriptive statistics were generated, with 95% CI calculated for the study's primary outcome of seroprevalence. RESULTS: Among survey respondents (92 of 148, 62%), 61% were male, 44% were non-White, mean age was 31 years, 94% had no underlying conditions, and 52% were either family or internal medicine residents. During the study period, ≥32% reported cough, headache, or sore throat and 62% traveled outside of Wisconsin. Overall, 83% thought they had a COVID-19 exposure at work and 33% outside of work; 100% expressed any exposure. Of those exposed at work, 56% received COVID-19 pay, variously receiving 69 mean hours (range: 0-452). Ultimately, 82% (75 of 92) had an Ab test completed; 1 individual (1.3%; 95% CI: 0.0-3.9) tested seropositive, was not previously diagnosed, and had received COVID-19 pay. CONCLUSIONS: The low Ab seroprevalence found in resident and fellow physicians was similar to the concurrently reported 3.7% Ab-positive rate among 2456 Milwaukee-based staff in the same integrated health system. Ultimately, COVID-19 seroconversion may be nominal in properly protected resident and fellow physicians despite known potential exposures.

Implementing an Interprofessional Anti-Racism Training With Community Partners During a Pandemic: Outcomes and Recommended Strategies.

BACKGROUND: Motivated by racial injustice and COVID-19 disparities, health care and medical education are accelerating efforts to address racism and eliminate health disparities. METHODS: In consultation with a community partner, an interprofessional physician-led team prioritized and completed an 8-hour anti-racism training adapted for online delivery during a pandemic. RESULTS: Sixty-four percent of enrollees (25/36) completed the survey, 98% rated the training as valuable, 92% would recommend it to a colleague, 88% reported it would improve their clinical care, and 68% thought their ability to create an inclusive environment increased. DISCUSSION: Virtual anti-racism training is a valuable learning experience. Tools for adapting trainings on high-risk or emotionally charged topics to a virtual format are offered by participants and session leaders.

Continuity and Access in the Era of Part-Time Practice.

The number of physicians seeing patients part time is growing, an evolution that challenges the primary care pillars of continuity and access. The growth of part-time practice is a response to burnout and to the pressures facing primary care physicians. Physicians who work fewer clinical hours and thereby reduce burnout are more satisfied with their careers, less likely to leave their jobs, and provide a better patient experience. Primary care practices can make a number of adjustments to optimize continuity and access in this era of part-time practice. Moreover, physicians who work fewer clinical hours are equally capable of fostering trusting relationships with patients as physicians seeing patients full time.

Residency redesign to accommodate trends in geriatrics: an RC-FM variance to establish a patient-centered medical home in an assisted living facility.

BACKGROUND AND OBJECTIVES: Family physicians are poised to provide medical care to older adults residing in the broad range of facilities now currently available to this population. To date, geriatric training has focused on skilled nursing facilities, particularly for the required Review Committee for Family Medicine (RC-FM) longitudinal experience. This article describes the development and evaluation of an RC-FM approved assisted living curricular variance to the current nursing home longitudinal experience with emphasis on the principles of the Patient-centered Medical Home (PCMH) model and an interprofessional team concept. METHODS: Second- and third-year family medicine residents were assigned as the primary care providers for two continuity patients in an assisted living facility. Patients were seen bimonthly within the construct of an interprofessional geriatric team. During the 2-year curricular variance, assessment of residents' skills, knowledge, and attitudes of the residents was conducted before and after the experience through direct skills observations, written testing, and focus groups. RESULTS: Of 18 geriatric competencies evaluated by direct observation, there was statistically significant improvement in seven areas. The composite score for these competencies was statistically significant. The attitudinal scores were initially high and remained high throughout the 2-year period. Knowledge testing was not significantly different before or after the experience. CONCLUSIONS: The assisted living facility is a viable clinical educational setting to develop geriatric competencies within a PCMH model. Providing geriatric clinical opportunities across the continuum of care can better prepare family medicine residents for future practice.