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INTRODUCTION: Alaska Native and American Indian (ANAI) people have a smoking prevalence of 23%. Nicotine metabolite ratio (NMR) and genetic testing may enable tailored selection of tobacco cessation medication. AIMS AND METHODS: The purpose of this study was to evaluate the relative contributions of NMR, cessation medication, demographics, and tobacco use history to cessation. Participants were recruited into an observational cohort study consisting of a baseline visit prior to their quit date and 6-week follow-up. Demographic and tobacco use surveys and blood, urine, and breath samples were collected at each visit. Electronic health records were queried for cessation medications. NMR was categorized into slow or normal nicotine metabolism phenotypes (<0.31 andâ ≥â 0.31, respectively). The main outcome was cessation at 6 weeks. Analyses consisted of descriptive statistics, medication and phenotype concordance, and estimates of relative risk (RR) of quitting. RESULTS: We enrolled 151 ANAI adults who smoked cigarettes daily. Two-thirds had normal nicotine metabolism phenotype. Retrospective medication and phenotype concordance was 39%. The overall quit rate was 25%. No demographic factors or tobacco use history were associated with quit success. Varenicline and bupropion increased the likelihood of quitting (RRâ =â 2.93 [1.42, 6.03] and RRâ =â 2.52 [1.12, 5.64], respectively) compared to nicotine replacement therapy. Non-optimal medication and phenotype concordance decreased likelihood of quit success (RRâ =â 0.44 [0.22, 0.91]) compared to optimal concordance. CONCLUSIONS: This exploratory study found associations between quit success and tobacco cessation medication as well as medication and phenotype concordance. Additional research is needed to assess use of NMR for treatment selection among ANAI people. IMPLICATIONS: These results broadly support additional community-engaged research to improve medication and phenotype concordance in tribal health settings. Such future research on implementing meditcation and phenotype concordance holds promise to improve expectations, quit success, and health outcomes amongst individuals attempting to quit smoking.
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Abandono do Hábito de Fumar , Fatores Sociodemográficos , Adulto , Humanos , Indígena Americano ou Nativo do Alasca/genética , Nicotina/uso terapêutico , Agonistas Nicotínicos/uso terapêutico , Estudos Retrospectivos , Fumar/tratamento farmacológico , Abandono do Hábito de Fumar/métodos , Dispositivos para o Abandono do Uso de TabacoRESUMO
BACKGROUND: The objective of this study was to evaluate the spatial and temporal patterns of disease prevalence clusters of dengue (DENV), chikungunya (CHIKV) and Zika (ZIKV) virus and how socio-economic and climatic variables simultaneously influence the risk and rate of occurrence of infection in Mexico. METHODS: To determine the spatiotemporal clustering and the effect of climatic and socio-economic covariates on the rate of occurrence of disease and risk in Mexico, we applied correlation methods, seasonal and trend decomposition using locally estimated scatterplot smoothing, hotspot analysis and conditional autoregressive Bayesian models. RESULTS: We found cases of the disease are decreasing and a significant association between DENV, CHIKV and ZIKV cases and climatic and socio-economic variables. An increment of cases was identified in the northeastern, central west and southeastern regions of Mexico. Climatic and socio-economic covariates were significantly associated with the rate of occurrence and risk of the three arboviral disease cases. CONCLUSION: The association of climatic and socio-economic factors is predominant in the northeastern, central west and southeastern regions of Mexico. DENV, CHIKV and ZIKV cases showed an increased risk in several states in these regions and need urgent attention to allocate public health resources to the most vulnerable regions in Mexico.
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Febre de Chikungunya , Vírus Chikungunya , Vírus da Dengue , Dengue , Infecção por Zika virus , Zika virus , Humanos , Infecção por Zika virus/epidemiologia , Dengue/epidemiologia , México/epidemiologia , Teorema de Bayes , Febre de Chikungunya/epidemiologiaRESUMO
Vulnerable populations are those who experience disparity at a disproportionate rate. For this article, specific vulnerable populations of interest include people who experience intellectual or developmental disorders, mental illness, or substance misuse. Vulnerable populations are some of the most stigmatized populations in our society. Research shows that vulnerable populations receive less empathic care than general health care populations, resulting in reduced quality of care and disparities in health outcomes. Empathy, a necessary health care competency, is associated with improved patient outcomes, enhanced job satisfaction, and increased retention and resilience across health care professions. However, there is no current standard for how empathy is taught, assessed, or sustained. Even when empathy education is implemented in healthcare professions curricula, research has demonstrated that it appears to erode with experience and time. In addition, the COVID-19 pandemic has exacerbated inequities in health care systems, with consequences for both patients and providers. There is an urgent need to develop efficacious training in empathy across health care professions to foster and sustain a robust workforce and improve health care experiences and outcomes.
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COVID-19 , Educação em Farmácia , Humanos , Empatia , Pandemias , COVID-19/epidemiologia , Atenção à SaúdeRESUMO
Empathy, the process of coming to know, understand, and care for another person, is a skill that can be learned; however, there is not a shared definition of empathy or understanding of how to operationalize empathy into practice. Healthcare worker empathy has been shown to have a beneficial effect on both patient health outcomes and the emotional wellness of healthcare workers. Empathic care is associated with more efficient, cost-effective, improved healthcare, and increased provider trust. The purpose of this rapid scoping review is to identify, compare, and contrast empathy training offered to select healthcare professional students (e.g., nurses, nurse practitioners, and pharmacists) as part of the general curriculum or as an elective. We utilized a rapid scoping review approach to identify potentially relevant peer-reviewed articles and studies for inclusion. Six electronic databases were searched, including: MEDLINE; EMBASE; PUBMed; CINAHL; EBSCOHOST; and ERIC, covering the past 10 years. A total of 4977 citations, 3480 abstracts, and 428 papers were screened. Fifty studies fulfilled the eligibility criteria. Of those, 21 primarily non-randomized experimental studies published between 2012 and 2021 were included in the final review. Over 80 percent of the training took place in the classroom setting and utilized active learning strategies. There is little consensus on how to best train future healthcare providers to provide empathic care to patients.
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Surveys are a common tool utilized by organizations and researchers to collect data and evaluate various populations. This project aimed to consolidate a list of national health surveys to make the data source identification process easier when utilizing survey data. A cross-sectional analysis of currently available national survey data was conducted using information from the Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services website. Surveys were assessed for inclusion criteria, and then data on diagnosis of chronic diseases and social determinants of health (SDoH) were extracted from included surveys. A total of 39 data sources were identified. After screening, 16 surveys met inclusion criteria and were included in the extraction process. This project identified 16 national health surveys containing questions related to chronic disease(s) and SDoH, which can be used to answer clinical, educational, and research questions. National surveys presented cover a broad range of topics, and these surveys may meet a variety of user needs.
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Pesquisadores , Determinantes Sociais da Saúde , Estados Unidos , Humanos , Estudos Transversais , Doença Crônica , EscolaridadeRESUMO
Triticeae crops are major contributors to global food production and ensuring their capacity to reproduce and generate seeds is critical. However, despite their importance our knowledge of the proteins underlying Triticeae reproduction is severely lacking and this is not only true of pollen and stigma development, but also of their pivotal interaction. When the pollen grain and stigma are brought together they have each accumulated the proteins required for their intended meeting and accordingly studying their mature proteomes is bound to reveal proteins involved in their diverse and complex interactions. Using triticale as a Triticeae representative, gel-free shotgun proteomics was used to identify 11,533 and 2977 mature stigma and pollen proteins respectively. These datasets, by far the largest to date, provide unprecedented insights into the proteins participating in Triticeae pollen and stigma development and interactions. The study of the Triticeae stigma has been particularly neglected. To begin filling this knowledge gap, a developmental iTRAQ analysis was performed revealing 647 proteins displaying differential abundance as the stigma matures in preparation for pollination. An in-depth comparison to an equivalent Brassicaceae analysis divulged both conservation and diversification in the makeup and function of proteins involved in the pollen and stigma encounter. SIGNIFICANCE: Successful pollination brings together the mature pollen and stigma thus initiating an intricate series of molecular processes vital to crop reproduction. In the Triticeae crops (e.g. wheat, barley, rye, triticale) there persists a vast deficit in our knowledge of the proteins involved which needs to be addressed if we are to face the many upcoming challenges to crop production such as those associated with climate change. At maturity, both the pollen and stigma have acquired the protein complement necessary for their forthcoming encounter and investigating their proteomes will inevitably provide unprecedented insights into the proteins enabling their interactions. By combining the analysis of the most comprehensive Triticeae pollen and stigma global proteome datasets to date with developmental iTRAQ investigations, proteins implicated in the different phases of pollen-stigma interaction enabling pollen adhesion, recognition, hydration, germination and tube growth, as well as those underlying stigma development were revealed. Extensive comparisons between equivalent Triticeae and Brassiceae datasets highlighted both the conservation of biological processes in line with the shared goal of activating the pollen grain and promoting pollen tube invasion of the pistil to effect fertilization, as well as the significant distinctions in their proteomes consistent with the considerable differences in their biochemistry, physiology and morphology.
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Proteoma , Triticale , Proteoma/metabolismo , Pólen/metabolismo , Poaceae , Alérgenos/metabolismo , Polinização , Flores/metabolismo , Tubo PolínicoRESUMO
BACKGROUND: Despite the established efficacy of vaccines, many Alaskans choose not to be vaccinated, citing safety and efficacy concerns. Vaccine hesitancy, consistently ranked among the top 10, is one of most addressable global health threats. The main objective of this paper is to provide an overview of the steps taken by our team to help identify and address vaccine hesitancy by identifying unmet training needs and engaging pharmacists, pharmacy interns, and technicians in the development of tailored vaccine hesitancy education to improve vaccine confidence and vaccination rates among all Alaskans. METHODS: To determine the unmet training needs that contributed to vaccine hesitancy, an assessment survey was developed and administered to pharmacists across the state. RESULTS: An expert panel, composed of pharmacists across the state, was convened to review survey results and to establish a scalable health care provider training program. Adult-learning strategies and real-world examples were used to address pharmacist identified factors contributing to vaccine hesitancy and provide more tailored training to pharmacists and technicians in Alaska to help address factors contributing to vaccine hesitancy in patients that may be extending the pandemic. CONCLUSION: Pharmacy professionals are well positioned to respond to emerging threats, but more training and practice opportunities are required to get comfortable addressing vaccine hesitancy with established communication strategies.
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Farmacêuticos , Vacinas , Adulto , Humanos , Alaska , Pandemias , VacinaçãoRESUMO
Background: In April 2020, pharmacists were added as medical providers under Idaho Medicaid in response to recent scope expansion for pharmacists and to increase beneficiaries' access to coronavirus disease 2019 (COVID-19) testing and services. The COVID-19 pandemic prompted expedited Medicaid enrollment for pharmacists but did not address coverage of medical services provided to privately insured individuals for pharmacy-based testing services. Objective: This study aimed to describe processes used by independently owned, community-based pharmacies in Idaho to credential with private insurers and report outcomes. Methods: Relevant information and forms required to credential with the four major payers in the state of Idaho were collected. Packets were obtained via medical insurers' websites and by direct contact. Questions that arose from community pharmacists during the submission process were collected and answered on a shared spreadsheet, and insurance representatives were contacted directly to resolve questions. Results: Eight out of 13 participating pharmacies submitted an average of three credentialing packets for their facilities. Thirty-five pharmacists also submitted an average of four credentialing packets for themselves. As of mid-May 2021, nearly 20 weeks after submission, only 67 out of 129 pharmacists had received word regarding the status of their applications. Less than half of all pharmacist applications were approved (after their first attempt). Conclusion: Efforts to support the education of both pharmacists and medical insurers may streamline the credentialing processes in the future.
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COVID-19 , Serviços Comunitários de Farmácia , Farmácias , Humanos , Pandemias , Teste para COVID-19 , Credenciamento , FarmacêuticosRESUMO
BACKGROUND: Pharmacists have the necessary clinical experience and medication knowledge to effectively provide diabetes self-management education and support (DSMES); however, barriers exist to DSMES implementation by community pharmacists. OBJECTIVE: The aim of this study is to explore DSMES from the community pharmacists' perspectives, identify barriers and facilitators to pharmacist DSMES implementation, and guide development of pharmacist-provided DSMES programs in Idaho. METHODS: Implementation climate, the theoretical framework for this project, is focused on how community pharmacists in Idaho perceive they will be supported by patients, health care providers, and insurers in DSMES implementation. Pharmacist investigators with qualitative research experience conducted semistructured interviews with 6 licensed community pharmacists from Idaho via Zoom between March and June 2020. Recordings were transcribed verbatim and analyzed using HyperRESEARCH 4.5.1. Themes, patterns, and dominant concepts that emerged from respondents' about DSMES were explored, labeled, and categorized into modifiable and nonmodifiable barriers and facilitators. This study was granted expedited approval by the Idaho State University Investigational Review Board. RESULTS: Relevant themes included current scope of practice, barriers, and facilitators. Subthemes related to the current scope of pharmacy practice included unclear roles and responsibilities and legislative constraints to practice. For barriers, subthemes included cost of set-up, billing and coding education, and the sustainability of services based on current reimbursement models. For facilitators, subthemes included the need for additional collaborations (external and internal), technology access, and trained pharmacy staff. CONCLUSION: Pharmacists are underutilized health care providers, capable of providing DSMES services if provided the necessary resources. This work identifies barriers and facilitators to pharmacist-led DSMES that can be considered by others when implementing DSMES or other disease management services.
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Serviços Comunitários de Farmácia , Diabetes Mellitus , Autogestão , Humanos , Farmacêuticos , Atitude do Pessoal de Saúde , Diabetes Mellitus/tratamento farmacológico , Papel ProfissionalRESUMO
Background: Artificial intelligence (AI) is as a branch of computer science that uses advanced computational methods such as machine learning (ML), to calculate and/or predict health outcomes and address patient and provider health needs. While these technologies show great promise for improving healthcare, especially in diabetes management, there are usability and safety concerns for both patients and providers about the use of AI/ML in healthcare management. Objectives: To support and ensure safe use of AI/ML technologies in healthcare, the team worked to better understand: 1) patient information and training needs, 2) the factors that influence patients' perceived value and trust in AI/ML healthcare applications; and 3) on how best to support safe and appropriate use of AI/ML enabled devices and applications among people living with diabetes. Methods: To understand general patient perspectives and information needs related to the use of AI/ML in healthcare, we conducted a series of focus groups (n=9) and interviews (n=3) with patients (n=40) and interviews with providers (n=6) in Alaska, Idaho, and Virginia. Grounded Theory guided data gathering, synthesis, and analysis. Thematic content and constant comparison analysis were used to identify relevant themes and sub-themes. Inductive approaches were used to link data to key concepts including preferred patient-provider-interactions, patient perceptions of trust, accuracy, value, assurances, and information transparency. Results: Key summary themes and recommendations focused on: 1) patient preferences for AI/ML enabled device and/or application information; 2) patient and provider AI/ML-related device and/or application training needs; 3) factors contributing to patient and provider trust in AI/ML enabled devices and/or application; and 4) AI/ML-related device and/or application functionality and safety considerations. A number of participant (patients and providers) recommendations to improve device functionality to guide information and labeling mandates (e.g., links to online video resources, and access to 24/7 live in-person or virtual emergency support). Other patient recommendations include: 1) access to practice devices; 2) connection to local supports and reputable community resources; 3) simplified display and alert limits. Conclusion: Recommendations from both patients and providers could be used by Federal Oversight Agencies to improve utilization of AI/ML monitoring of technology use in diabetes, improving device safety and efficacy.
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Vaccination remains one of the most effective ways to limit the spread of infectious diseases, and reduce mortality and morbidity in rural areas. Waning public confidence in vaccines, especially the COVID-19 vaccine, remains a cause for concern. A number of individuals in the US and worldwide remain complacent, choosing not to be vaccinated and/or delay COVID-19 vaccination, resulting in suboptimal herd immunity. The primary goal of this study is to identify modifiable factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to vaccines in two under-resourced rural states, Alaska and Idaho. This qualitative study used semi-structured interviews with providers and focus groups with community participants in Alaska and Idaho. A moderator's guide was used to facilitate interviews and focus groups conducted and recorded using Zoom and transcribed verbatim. Thematic, qualitative analysis was conducted using QDA Miner. Themes and subthemes that emerged were labeled, categorized, and compared to previously described determinants of general vaccine hesitancy: established contextual, individual and/or social influences, vaccine and vaccination-specific concerns. Themes (n = 9) and sub-themes (n = 51) identified during the qualitative analysis highlighted a factor's contributing to COVID-19 vaccine hesitancy and poor vaccine uptake. Relevant influenceable factors were grouped into three main categories: confidence, complacency, and convenience. Vaccines are effective public health interventions to promote health and prevent diseases in rural areas. Practical solutions to engage healthcare providers, researchers, vaccine advocates, vaccine manufacturers, and other partners in local communities are needed to increase public trust in immunization systems to achieve community immunity.
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Introduction: Fragility fractures (low-energy, minimal-trauma fractures) are common in the aging population and can lead to decreased function, increased mortality, and long-lasting pain. Although opioids are helpful in reducing acute postoperative pain, they present risks that may lead to increased morbidity and mortality. Materials and Methods: This was a retrospective review of medical records of all Alaska Native and American Indian people older than 50 years, who received surgery for hip fracture repair between January 2018 and June 2019 (n = 128). Results: We found that receipt of a peripheral nerve block (PNB) is a predictor for decreased length of hospital stay. However, receipt of PNB did not predict a reduction in postoperative morphine milligram equivalents opioid doses. Discussion: Further study is required to determine whether one PNB method is superior to others based on individual-level characteristics.
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Vaccination remains one of the most effective ways to limit spread of disease. Waning public confidence in COVID-19 vaccines has resulted in reduced vaccination rates. In fact, despite vaccine availability, many individuals choose to delay COVID-19 vaccination resulting in suboptimal herd immunity and increased viral mutations. A number of qualitative and quantitative studies have been conducted to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among individuals with access to vaccine. Vaccine confidence may be improved through targeted patient-provider discussion. More patients are turning to pharmacists to receive their vaccinations across the lifespan. The primary goal of this commentary is to share evidence-based, patient talking points, tailored by practicing pharmacists, to better communicate and address factors contributing to vaccine hesitancy and reduced vaccine confidence.
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Participant retention in longitudinal health research is necessary for generalizable results. Understanding factors that correlate with increased retention could improve retention in future studies. Here, we describe how participant and study process measures are associated with retention in a longitudinal tobacco cessation research study performed in Anchorage, Alaska. Specifically, we conducted a secondary analysis exploring retention among 151 Alaska Native and American Indian (ANAI) people and described our study processes using study retention categories from a recent meta-analysis. We found that our study processes influence retention among ANAI urban residents more than measures collected about the participant. For study process measures, calls where a participant answered and calls participants placed to the study team were associated with higher retention. Calls where the participant did not answer were associated with lower retention. For participant measures, only lower annual income was associated with lower retention at 6 weeks. Promoting communication from participants to the study team could improve retention, and alternative communication methods could be used after unsuccessful calls. Finally, categorizing our study retention strategies demonstrated that additional barrier-reduction strategies might be warranted.
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Indígenas Norte-Americanos , Abandono do Hábito de Fumar , Alaska , Humanos , Estudos Longitudinais , Abandono do Hábito de Fumar/métodosRESUMO
BACKGROUND: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. OBJECTIVE: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. METHODS: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators' previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ≥18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. RESULTS: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent's health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. CONCLUSIONS: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers.
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Despite the positive impact pharmacists have had on access to vaccines, only a limited number of community pharmacists and pharmacies are able to participate in most federal- and state-supported vaccine programs. In this commentary we (1) review vaccination services currently provided by community pharmacists in the United States, (2) highlight regulatory, reimbursement, and role-based barriers to community pharmacists' participation in the vaccines for children (VFC) program, a cornerstone program to support vaccinations of children in the United States, and (3) suggest changes to support and improve VFC participation for all health care providers. For the purposes of this commentary, community pharmacies are defined as retail pharmacies not associated with a health care system, hospital, or clinic.
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Serviços Comunitários de Farmácia , Farmácias , Criança , Atenção à Saúde , Humanos , Programas de Imunização , Farmacêuticos , Estados Unidos , VacinaçãoRESUMO
Background: Pharmacists are well trained, readily accessible health care professionals (HCPs) who practice in a variety of inpatient and outpatient mental health settings. Observations: As part of the interdisciplinary team, pharmacists can help address HCP shortages. Pharmacists currently are providing mental health collaborative practice services at US Department of Veterans Affairs (VA) facilities. Conclusions: Collaborative practice services can be expanded within and outside the VA by using pharmacists to increase access to care and improve outcomes.
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BACKGROUND: In the United States, healthcare providers document and code healthcare encounters and submit claims to insurers for reimbursement. Most providers eligible for individual-level insurer reimbursement do not receive coding/billing training. The purpose of this commentary is to provide an overview of training disparities. METHODS: The top 100 universities within five healthcare disciplines (dietetics, nursing, pharmacy, social work, medicine) were asked about available didactic curriculum and coding resources provided during training. Results were compared across disciplines, by geographic region, funding mechanism, and size. RESULTS: Twenty-seven percent of schools/universities contacted participated; the response was greater among public institutions (73%) and varied by discipline. Coverage of coding/billing in the didactic curriculum varied: it was covered in 40 dietetics programs (93%), 23 nursing programs (57%), and 14 pharmacy programs (28%). None of the 36 social work programs covered coding/billing, and only 5% of the 20 medical schools did. No statistically significant differences by region or funding were noted; however, coverage of coding/billing in the curriculum did differ by discipline (p<0.0001). DISCUSSION: Upon graduation, healthcare providers may be ill-prepared to code/bill for services. This knowledge is crucial for sustainable health service provision and does not appear to be consistently provided within curriculum to healthcare students. Further study is needed to understand and address this training gap.
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Dietética , Pessoal de Saúde , Currículo , Atenção à Saúde , Humanos , Estados UnidosRESUMO
The prevalence of self-reported hypertension is higher among Alaska Native and American Indian (ANAI) individuals than in the majority USA population. Although hypertension is the primary modifiable risk factor for cardiovascular disease and stroke, it can be difficult to manage successfully. The objective of this study was to explore patients' and providers' perspectives about hypertension, hypertension management strategies, and patient-provider communication strategies within a tribally-owned and operated health system in Alaska. We conducted four focus groups that included 16 ANAI patients and five primary care providers. Patient participants tended to consider hypertension a transient state, in contrast with providers' understanding of hypertension as a chronic condition. Differences were noted in participants' perceptions regarding providers' counselling and education efforts, with providers feeling that current strategies are effective and patients desiring a more personalised discussion about hypertension. Patients expressed preferences for behaviour change approaches compared with pharmacotherapy; providers often resorted to medication as a first step towards controlling blood pressure. Our findings suggest areas of potentially promising future research with respect to patient-provider communication and treatment of hypertension.