RESUMO
The recently released JNC 8 guideline on hypertension management is a major departure from previous JNC guidelines in methodology, focus, and content. This article reviews the design and content of the new guideline as well as its similarities and differences from JNC 7 and other recently published hypertension guidelines.
Assuntos
Anti-Hipertensivos/uso terapêutico , Diuréticos/uso terapêutico , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , HumanosRESUMO
Patients with kidney disease often have a poor understanding of their condition. The interdisciplinary team can effectively educate these patients to slow disease progression and enhance self-management. The kidney community needs large, well-designed studies to determine the best way to educate patients and hopefully stem the tide of a rapidly increasing population of kidney patients. Congress authorized payment to eligible providers for kidney disease education for Medicare beneficiaries. However, this benefit is not being optimally used. In addition, reimbursement denials were 14-17% in 2011 and 20-23% in 2012. This is more than 4 times the usual Medicare denial rate for current procedural terminology (CPT) codes.
Assuntos
Equipe de Assistência ao Paciente , Educação de Pacientes como Assunto/métodos , Insuficiência Renal Crônica/terapia , Autocuidado/métodos , Humanos , Medicare/economia , Educação de Pacientes como Assunto/economia , Mecanismo de Reembolso/economia , Estados UnidosAssuntos
Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/terapia , Assistentes Médicos/psicologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Injúria Renal Aguda/psicologia , Adulto , Idoso , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/psicologiaRESUMO
The passage of the Medicare Improvements for Patients and Providers Act (MIPPA) encouraged education for Stage 4 CKD patients by reimbursing qualified providers for formal instruction. This marked the first time Medicare reimbursed for kidney disease education. Although the law lays out specific requirements, it leaves much of the structure and content of the instruction up to the providers. The CKD clinic staffed by advanced practitioners (physician assistants, nurse practitioners, and/or clinical nurse specialists) provides a natural fit for patient education. Educated patients choose home modalities more frequently; more often start dialysis with a permanent vascular access; and generally score higher on tests measuring mood, mobility, and anxiety. However, sufficient research into the effects of CKD patient education is lacking.