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1.
Circulation ; : CIR0000000000000803, 2020 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-32567342

RESUMEN

The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.

2.
Circ Cardiovasc Qual Outcomes ; 13(3): e006115, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32142371

RESUMEN

BACKGROUND: Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. METHODS AND RESULTS: The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. CONCLUSIONS: The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.

3.
Artículo en Español | PAHO-IRIS | ID: phr-51862

RESUMEN

[RESUMEN]. La Comisión Lancet de Hipertensión determinó que una medida clave para responder a la carga mundial que representa la hipertensión arterial era mejorar la calidad de las mediciones de la presión arterial, mediante la utilización de dispositivos cuya exactitud haya sido validada. En la actualidad existen 3000 dispositivos comercializados, pero muchos no tienen datos publicados sobre pruebas de exactitud conformes a las normas científicas establecidas. La falta de regulación o su ineficiencia, que permiten la autorización de dispositivos para uso comercial sin una validación oficial, posibilitan este problema. Además, han surgido tecnologías nuevas de medición de la presión arterial (por ejemplo, los sensores sin brazalete) sobre las cuales no existe unanimidad en la comunidad científica con respecto a las normas de exactitud de la medición. En conjunto, estos aspectos contribuyen a la disponibilidad generalizada de tensiómetros de consultorio o domiciliarios que ofrecen una exactitud limitada o incierta, que llevan a diagnósticos, manejo y farmacoterapia inapropiados de la hipertensión a escala mundial. Los problemas más importantes relacionados con la exactitud de los dispositivos de medición de la presión arterial se pueden resolver mediante el requisito regulatorio de una validación independiente obligatoria de los dispositivos, en consonancia con la norma ISO universalmente aceptada. Esta es una recomendación básica y constituye una necesidad internacional acuciante. Otras recomendaciones clave son la elaboración de normas de validación específicas para las tecnologías nuevas de medición de la presión arterial y la publicación en línea de listas de los dispositivos nuevos exactos que están a la disposición de los usuarios y los profesionales de salud. Las recomendaciones están en consonancia con las políticas de la Organización Mundial de la Salud sobre los dispositivos médicos y la atención universal de la salud. El cumplimiento de las recomendaciones aumentará la disponibilidad mundial de dispositivos de medición de la presión arterial que sean exactos y tendrá como efecto un mejor diagnóstico y tratamiento, reduciendo así la carga mundial de la hipertensión.


[ABSTRACT]. The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.


[RESUMO]. A Comissão Lancet sobre Hipertensão Arterial identificou que uma iniciativa central para enfrentar a carga mundial da hipertensão arterial seria a melhoria na qualidade da mensuração da pressão arterial pelo uso aparelhos de pressão arterial validados quanto à acurácia. Atualmente, existem mais de 3 000 aparelhos de pressão arterial disponíveis comercialmente; entretanto, muitos não têm dados publicados sobre testes de acurácia realizados de acordo com padrões científicos estabelecidos. Este problema resulta de regulamentação fraca ou inexistente, o que permite a aprovação para uso comercial de dispositivos sem validação formal. Além disso, surgiram novas tecnologias de mensuração da pressão arterial (por exemplo, sensores sem algemas) sem consenso científico quanto aos padrões de acurácia. No conjunto, essas questões contribuem para a oferta generalizada de dispositivos de pressão arterial clínica e domiciliar com acurácia limitada ou incerta, levando a diagnóstico, gerenciamento e tratamento inadequados da hipertensão em escala global. Os problemas mais significativos relacionados com a acurácia dos dispositivos de pressão arterial podem ser resolvidos por regulamentação que imponha a obrigatoriedade de validação independente dos aparelhos de pressão arterial, de acordo com a norma universalmente aceita pela Organização Internacional de Normalização. Esta é uma recomendação fundamental para a qual existe uma necessidade internacional urgente. Outras recomendações essenciais incluem o desenvolvimento de padrões de validação especificamente para novas tecnologias de mensuração da pressão arterial e listas on-line de aparelhos com acurácia adequada que sejam acessíveis aos consumidores e profissionais de saúde. As recomendações estão alinhadas com as políticas da Organização Mundial da Saúde (OMS) sobre dispositivos médicos e atenção universal à saúde. A adesão às recomendações aumentaria a oferta global de dispositivos de pressão arterial com acurácia adequada e resultaria em melhor diagnóstico e tratamento da hipertensão arterial, diminuindo assim a carga mundial dessa doença.


Asunto(s)
Salud Global , Tecnología Biomédica , Estándares de Referencia , Equipo para Diagnóstico , Salud Global , Tecnología Biomédica , Estándares de Referencia , Equipo para Diagnóstico , Salud Global , Tecnología Biomédica , Estándares de Referencia , Equipo para Diagnóstico
4.
Popul Health Manag ; 2020 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-32013762

RESUMEN

Diabetes is a costly chronic condition in the United States. The incremental increase in costs of the disease can begin and accelerate prior to first diagnosis. This study conducts a retrospective analysis of claims data from Truven Health MarketScan® Commercial Claims Database to track per capita annual medical expenditures among a single panel of commercially insured patients for 5 years preceding a new diabetes diagnosis. Case subjects, defined as individuals newly diagnosed with diabetes in 2014, are compared to control subjects, defined as individuals who do not have a diabetes diagnosis. Arithmetic means, compound annual growth rates, and propensity score matching models are used to track the differential in expenditures across health care sectors. This analysis finds that the incremental rise in costs of diabetes are shown to begin at least 5 years before diagnosis of the disease and accelerate immediately after diagnosis. Results of the matching model suggest that the newly diagnosed case subjects spent $8941 more than control subjects not diagnosed with diabetes over the span of 5 years, with approximately $4828 in the year of diagnosis. The compounded annual growth rate in per capita annual medical expenditures between 2010-2014 was almost 9% higher among case subjects at 14.3% in the matched models. Results show that the rise in medical spending associated with diabetes begins well in advance of the first diabetes diagnosis and support the need to encourage physicians to implement timely identification and prevention efforts to reduce the economic burden of the disease.

5.
Rev. panam. salud pública ; 44: e21, 2020. tab
Artículo en Español | LILACS-Express | ID: biblio-1101778

RESUMEN

resumen está disponible en el texto completo


ABSTRACT The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.


RESUMO A Comissão Lancet sobre Hipertensão Arterial identificou que uma iniciativa central para enfrentar a carga mundial da hipertensão arterial seria a melhoria na qualidade da mensuração da pressão arterial pelo uso aparelhos de pressão arterial validados quanto à acurácia. Atualmente, existem mais de 3 000 aparelhos de pressão arterial disponíveis comercialmente; entretanto, muitos não têm dados publicados sobre testes de acurácia realizados de acordo com padrões científicos estabelecidos. Este problema resulta de regulamentação fraca ou inexistente, o que permite a aprovação para uso comercial de dispositivos sem validação formal. Além disso, surgiram novas tecnologias de mensuração da pressão arterial (por exemplo, sensores sem algemas) sem consenso científico quanto aos padrões de acurácia. No conjunto, essas questões contribuem para a oferta generalizada de dispositivos de pressão arterial clínica e domiciliar com acurácia limitada ou incerta, levando a diagnóstico, gerenciamento e tratamento inadequados da hipertensão em escala global. Os problemas mais significativos relacionados com a acurácia dos dispositivos de pressão arterial podem ser resolvidos por regulamentação que imponha a obrigatoriedade de validação independente dos aparelhos de pressão arterial, de acordo com a norma universalmente aceita pela Organização Internacional de Normalização. Esta é uma recomendação fundamental para a qual existe uma necessidade internacional urgente. Outras recomendações essenciais incluem o desenvolvimento de padrões de validação especificamente para novas tecnologias de mensuração da pressão arterial e listas on-line de aparelhos com acurácia adequada que sejam acessíveis aos consumidores e profissionais de saúde. As recomendações estão alinhadas com as políticas da Organização Mundial da Saúde (OMS) sobre dispositivos médicos e atenção universal à saúde. A adesão às recomendações aumentaria a oferta global de dispositivos de pressão arterial com acurácia adequada e resultaria em melhor diagnóstico e tratamento da hipertensão arterial, diminuindo assim a carga mundial dessa doença.

6.
J Hypertens ; 38(1): 21-29, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31790375

RESUMEN

: The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organisation for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.

10.
BMC Med Educ ; 19(1): 285, 2019 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-31357985

RESUMEN

BACKGROUND: The United States has 84 million adults with prediabetes, putting them at a higher risk than the general population for developing type 2 diabetes. Missed opportunities among primary care providers in diagnosing and managing patients with prediabetes represent a gap in care, suggesting there is a need to educate practicing physicians and medical students about diabetes prevention. The purpose of this study is to assess medical students' basic knowledge of prediabetes and diabetes prevention, identify potential educational needs, and target areas for improvement in undergraduate medical education curricula. METHODS: A cross-sectional study to assess medical students' preclinical and clinical management knowledge of prediabetes and diabetes prevention. Medical students attending the 2016 American Medical Association's annual meeting took a 6-item knowledge questionnaire using a mobile application or a paper version. Scores were reported for the full sample of respondents, by year in medical school, by topic area, and by mode of survey response. RESULTS: The average student answered fewer than half of the questionnaire questions correctly. Scores on some items addressing preclinical content were higher among third- and fourth-year students compared to first- and second-year students (p = 0.039 and effect size = 0.363). Average scores on the items addressing clinical management were not significantly different by year in medical school, but the item measuring effectiveness of metformin to a lifestyle change program had 41.9% correct answers among the mobile application respondents compared to 21.5% among paper test respondents (p = 0.003 and effect size = 0.463). CONCLUSIONS: Medical student performance on the prediabetes knowledge questionnaire was low. Students' year in medical school had a slight impact on overall performance, but only for certain questions. The results suggest the need for improvements in current medical school curricula for increasing the awareness of screening for prediabetes as well as the benefits of the lifestyle change programs in the National Diabetes Prevention Program.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Evaluación Educacional , Estado Prediabético , Estudiantes de Medicina , Estudios Transversales , Diabetes Mellitus Tipo 2/etiología , Educación de Pregrado en Medicina , Humanos , Encuestas y Cuestionarios
11.
J Hypertens ; 37(9): 1737-1745, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31034450

RESUMEN

: High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-to-middle-income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.

12.
Hypertension ; 72(6): 1320-1327, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30571231

RESUMEN

Better blood pressure (BP; mm Hg) control is a pivotal national strategy for preventing cardiovascular events. Measure accurately, Act rapidly, and Partner with patients (MAP) with practice facilitation improved BP control (<140/<90 mm Hg) from 61.2% to 89.8% during a 6-month pilot study in one primary care clinic. Current study objectives included evaluating the 6-month MAP framework in 16 Family Medicine Clinics and then withdrawing practice facilitation and determining whether better hypertension control persisted at 12 months since short-term improvements often decline by 1 year. Measure accurately included staff training in attended (intake) BP measurement and unattended automated office BP when intake BP was ≥140/≥90 mm Hg. Act rapidly (therapeutic inertia) included protocol-guided escalation of antihypertensive medications when office BP was ≥140/≥90 mm Hg. Partner with patients (systolic BP decline/therapeutic intensification) included shared decision making, BP self-monitoring, and affordable medications. Study data were obtained from electronic records. In 16 787 hypertensive adults (mean, 61.2 years; 54.1% women; 46.0% Medicare) with visits at baseline and first 6 months, BP control improved from 64.4% at baseline to 74.3% ( P<0.001) at 6 and 73.6% ( P<0.001) at 12 months. At the first MAP visit, among adults with uncontrolled baseline BP and no medication changes (n=3654), measure accurately resulted in 11.1/5.1 mm Hg lower BP. During the first 6 months of MAP, therapeutic inertia fell (52.0% versus 49.5%; P=0.01), and systolic BP decreased more per therapeutic intensification (-5.4 to -12.7; P<0.001). MAP supports a key national strategy for cardiovascular disease prevention through rapid and sustained improvement in hypertension control, largely reflecting measuring accurately and partnering with patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Anciano , Antihipertensivos/farmacología , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Proyectos Piloto , Atención Primaria de Salud
13.
J Clin Hypertens (Greenwich) ; 20(10): 1377-1391, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30194806

RESUMEN

Application of the 2017 ACC/AHA Hypertension Guideline expands the number of US adults requiring blood pressure (BP) management. The authors use 2011-2014 NHANES data to describe the population groups most affected by the new guideline, compared with the previous JNC-7 guideline, and describe the previous interaction with the health care sector among those adults recommended new or intensified pharmacologic treatment and/or lifestyle modification. The 2017 Hypertension Guideline reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment of 133.7 million adults, including 57.8 million with uncontrolled BP recommended to initiate or intensify pharmacologic treatment and 50.5 million newly recommended lifestyle modification alone. An estimated 13.1 million (22.7%) adults recommended to initiate or intensify pharmacologic treatment, and 20.6 million (40.8%) adults newly recommended lifestyle modification alone report not having established health care linkages. Among the adults newly recommended lifestyle modification alone, the odds of reclassification from no recommended intervention, under JNC-7, to recommended lifestyle modification alone were lower for adults with established linkages to care (aOR: 0.78 [95% CI: 0.67-0.91]) compared to those without, decreased with increasing age, were greater for men (1.72 [1.52-1.94]) compared to women and were greater for obese adults (1.23 [1.00-1.53]) compared with normal or underweight adults. Application of the 2017 Hypertension Guideline increases the number and alters the distribution of US adults in need of initiating or intensifying BP treatment. This includes identifying millions of US adults who previously had limited interaction with health care and are now recommended new or intensified pharmacologic treatment and/or lifestyle modification.


Asunto(s)
Determinación de la Presión Sanguínea/métodos , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Hipertensión/psicología , Adolescente , Adulto , Anciano , American Heart Association , American Medical Association/organización & administración , Femenino , Guías como Asunto , Humanos , Hipertensión/epidemiología , Estilo de Vida , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Conducta de Reducción del Riesgo , Estados Unidos/epidemiología
14.
Am J Prev Med ; 55(2): e39-e47, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29934016

RESUMEN

INTRODUCTION: Intensive behavioral counseling is effective in preventing type 2 diabetes, and insurance coverage for such interventions is increasing. Although primary care provider referrals are not required for entry to the Centers for Disease Control and Prevention (CDC)-recognized National Diabetes Prevention Program lifestyle change program, referral rates remain suboptimal. This study aims to assess the association between primary care provider behaviors regarding prediabetes screening, testing, and referral and awareness of the CDC-recognized lifestyle change program and the Prevent Diabetes STAT: Screen, Test, and Act Today™ toolkit. Awareness of the lifestyle change program and the STAT toolkit, use of electronic health records, and the ratio of lifestyle change program classes to primary care physicians were hypothesized to be positively associated with primary care provider prediabetes screening, testing, and referral behaviors. METHODS: Responses from primary care providers (n=1,256) who completed the 2016 DocStyles cross-sectional web-based survey were analyzed in 2017 to measure self-reported prediabetes screening, testing, and referral behaviors. Multivariate logistic regression was used to estimate the effects of primary care provider awareness and practice characteristics on these behaviors, controlling for provider characteristics. RESULTS: Overall, 38% of primary care providers were aware of the CDC-recognized lifestyle change program, and 19% were aware of the STAT toolkit; 27% screened patients for prediabetes using a risk test; 97% ordered recommended blood tests; and 23% made referrals. Awareness of the lifestyle change program and the STAT toolkit was positively associated with screening and referring patients. Primary care providers who used electronic health records were more likely to screen, test, and refer. Referring was more likely in areas with more lifestyle change program classes. CONCLUSIONS: This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.


Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Estilo de Vida , Tamizaje Masivo/estadística & datos numéricos , Médicos de Atención Primaria/estadística & datos numéricos , Estado Prediabético/epidemiología , Derivación y Consulta/estadística & datos numéricos , Actitud del Personal de Salud , Concienciación , Registros Electrónicos de Salud , Femenino , Humanos , Internet , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Encuestas y Cuestionarios , Estados Unidos/epidemiología
15.
J Clin Hypertens (Greenwich) ; 20(1): 79-87, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29316149

RESUMEN

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence-based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6-month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM-907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self-monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.


Asunto(s)
Determinación de la Presión Sanguínea , Equidad en Salud/organización & administración , Hipertensión , Atención al Paciente , Adulto , Anciano , Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/normas , Femenino , Accesibilidad a los Servicios de Salud/normas , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Hipertensión/psicología , Hipertensión/terapia , Masculino , Medicaid/estadística & datos numéricos , Área sin Atención Médica , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Atención al Paciente/métodos , Atención al Paciente/normas , Proyectos Piloto , Mejoramiento de la Calidad , Estados Unidos/epidemiología
16.
J Clin Hypertens (Greenwich) ; 19(6): 614-619, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28452119

RESUMEN

Blood pressure (BP) measurement is the most common procedure performed in clinical practice. Accurate BP measurement is critical if patient care is to be delivered with the highest quality, as stressed in published guidelines. Physician training in BP measurement is often limited to a brief demonstration during medical school without retraining in residency, fellowship, or clinical practice to maintain skills. One hundred fifty-nine students from medical schools in 37 states attending the American Medical Association's House of Delegates Meeting in June 2015 were assessed on an 11-element skillset on BP measurement. Only one student demonstrated proficiency on all 11 skills. The mean number of elements performed properly was 4.1. The findings suggest that changes in medical school curriculum emphasizing BP measurement are needed for medical students to become, and remain, proficient in BP measurement. Measuring BP correctly should be taught and reinforced throughout medical school, residency, and the entire career of clinicians.


Asunto(s)
American Medical Association/organización & administración , Determinación de la Presión Sanguínea/métodos , Presión Sanguínea/fisiología , Estudiantes de Medicina/estadística & datos numéricos , Adulto , Determinación de la Presión Sanguínea/instrumentación , Determinación de la Presión Sanguínea/estadística & datos numéricos , Competencia Clínica/normas , Curriculum/normas , Educación Médica/normas , Femenino , Humanos , Masculino , Estados Unidos/epidemiología
17.
Popul Health Manag ; 20(5): 389-396, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28192030

RESUMEN

The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.


Asunto(s)
Ahorro de Costo/estadística & datos numéricos , Diabetes Mellitus/prevención & control , Gastos en Salud/estadística & datos numéricos , Estado Prediabético , Conducta de Reducción del Riesgo , Adolescente , Adulto , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Estado Prediabético/economía , Estado Prediabético/epidemiología , Estado Prediabético/terapia , Factores de Riesgo , Adulto Joven
18.
PLoS One ; 11(7): e0159366, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27428008

RESUMEN

BACKGROUND: Effective hypertension management often necessitates patients' adherence to the blood pressure (BP)-lowering medication regimen they are prescribed. Patients' adherence to that regimen can be affected by prescription- and payment-related factors that are typically controlled by prescribers, filling pharmacies, pharmacy benefit managers, and/or patients' health insurance plans. This study describes patterns and changes from 2009 to 2014 in factors that the literature reports are associated with increased adherence to BP-lowering medication. METHODS AND FINDINGS: We use a robust source of United States prescription sales data-IMS Health's National Prescription Audit-to describe BP-lowering medication fill counts and spending in 2009 compared with 2014. Moreover, we describe patterns and changes in adherence-promoting factors across age groups, payment sources, and medication classes. From 2009 to 2014, the BP-lowering medication prescription fill count increased from 613.7 million to 653.0 million. Encouraging changes in adherence-promoting factors included: the share of generic fills increased from 82.5% to 95.0%; average days' supply per fill increased from 45.9 to 51.8 days; and average total (patient contribution) spending per years' supply decreased from $359 ($54) to $311 ($37). Possibly undesirable changes included: the percentage of fills for fixed-dose combinations decreased from 17.1% to 14.2% and acquired via mail order decreased from 10.7% to 8.2%. In 2014: 653.0 million fills occurred accounting for $28.81B in spending; adults aged 45-64 years had the highest percentage of fixed-dose combinations fills (16.9%); and fills with Medicaid as the payment source had the lowest average patient spending per fill ($1.19). CONCLUSIONS: We identified both encouraging and possibly undesirable patterns and changes from 2009 to 2014 in factors that promote adherence to BP-lowering medications during this period. Continued tracking of these metrics using pharmacy sales data can help identify areas that can be addressed by clinical and policy interventions to improve adherence for medications commonly used to treat hypertension.


Asunto(s)
Antihipertensivos/uso terapéutico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/uso terapéutico , Gastos en Salud/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Antihipertensivos/provisión & distribución , Presión Sanguínea/efectos de los fármacos , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Medicamentos Genéricos/provisión & distribución , Femenino , Humanos , Hipertensión/fisiopatología , Hipertensión/psicología , Masculino , Medicaid/economía , Persona de Mediana Edad , Estados Unidos
19.
J Clin Hypertens (Greenwich) ; 18(3): 232-9, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26337797

RESUMEN

Evidence-based interventions differ for increasing hypertension awareness, treatment, and control and should be targeted for specific patient panels. This study developed a hypertension control cascade to identify patients with a usual source of care represented at each level of the cascade using the 2007-2012 National Health and Nutrition Examination Survey. Overall, 10.7 million adults in the United States were unaware of their condition, 3.8 million were aware but untreated, and 15.8 million were treated but uncontrolled. The results also suggest that failure to attain hypertension control because of lack of awareness or lack of treatment despite awareness occurs mainly among younger individuals and those with no annual healthcare visits, while the elderly and minorities are more likely to remain uncontrolled when aware and treated. Opportunities to leverage population health management functions in electronic health information systems to align the specific patient subgroups facing barriers to hypertension control at each level of the cascade with targeted hypertension management interventions are discussed.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hipertensión/psicología , Hipertensión/terapia , Adulto , Factores de Edad , Registros Electrónicos de Salud , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
20.
J Am Coll Radiol ; 11(11): 1053-8, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25086957

RESUMEN

PURPOSE: Available data are limited on the level of adherence to established guidelines for appropriate utilization of MR in musculoskeletal imaging. This study estimates the percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography, which thus may fall outside the ACR Appropriateness Criteria for the Medicare and commercially insured populations. METHODS: The percentage of MRI examinations for knee and shoulder pain or tendonitis performed without prior radiography was estimated among patients in the Medicare 5% carrier claims limited data set and among commercially insured patients in the Truven Marketscan Treatment Pathways database in 2010. RESULTS: Approximately 28% of all knee MRIs, and 35%-37% of all shoulder MRIs were performed without recent prior radiographs. The extrapolated expense of these potentially unwarranted MRIs in the entire fee-for-service Medicare population was between $20 and $35 million. Between 20% and 23% of patients undergoing knee MRI, and 27%-32% undergoing shoulder MRI, did not have radiographic examination at any point before the MRI in the same calendar year. CONCLUSIONS: MRI performed without prior radiography represents a potential gap in care and should be considered as an area for establishment of performance measures.


Asunto(s)
Rodilla , Imagen por Resonancia Magnética/métodos , Dolor de Hombro/diagnóstico , Tendinopatía/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Medicare , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Tendinopatía/diagnóstico por imagen , Estados Unidos
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