Design of the Reducing Diagnostic Error to Improve Patient Safety (REDEfINE) in COPD and asthma study: A cluster randomized comparative effectiveness trial.

Although spirometry is a simple, portable test and recommended for the diagnosis of asthma and chronic obstructive pulmonary disease (COPD), it is not routinely used in the primary care setting. Minorities and underserved populations are less likely to have spirometry assessment, leading to both over and misdiagnosis of asthma and COPD. Because dyspnea is a common symptom across multiple diseases, use of spirometry as a diagnostic tool is important. Missed, delayed, or misdiagnosis of asthma and COPD, which are considered diagnostic errors (DE), can lead to poor quality of care, increased morbidity and mortality, and increased costs to patients and health systems. Barriers to the use of spirometry have been identified at clinician/clinic and health systems levels. The REDEFINE program is designed to overcome identified barriers to spirometry use in primary care by utilizing health promoters (HPs) who perform spirometry within primary care clinics and work collaboratively with clinicians to incorporate the results at the point of care without interrupting clinic workflow. The REDEFINE trial is a comparative effectiveness study comparing outcomes of the REDEFINE program with usual care (UC) in primary care patients determined to be at increased risk of DE for asthma and COPD. The primary outcome will be all-cause hospitalizations. The secondary outcomes will be the proportion of accurate diagnosis of COPD, asthma, or asthma-COPD overlap based on initial diagnosis and spirometry and all cause and respiratory-related acute outpatient care and emergency department visits. In this report, we describe the design and methods for the REDEFINE trial. Trial registration: NCT03137303https://clinicaltrials.gov/ct2/show/NCT03137303?term=REDEFINE&draw=2&rank=1.

Impact of exercise (walking) on blood pressure levels in African American adults with newly diagnosed hypertension.

OBJECTIVES: To determine whether the encouragement of walking an extra 30 minutes a day decreases blood pressure in adult African Americans with newly diagnosed hypertension. DESIGN: Randomized controlled study. PARTICIPANTS AND SETTING: A total of 19 African American adults with newly diagnosed hypertension from an urban family medicine office were randomly assigned to intervention and control groups. INTERVENTION: The intervention group was advised to walk an extra 30 minutes per day. The control group was not given this advice. All subjects used pedometers to record the number of daily steps. MAIN OUTCOME MEASURE: Change in systolic and diastolic blood pressure in the intervention and control groups after six months of trial, controlling for age and body mass index. RESULTS: At the end of six months, a mixed analysis of covariance did not reveal a significant group-by-time interaction for systolic blood pressure. However, positive effects of walking were evidenced; adjusted mean systolic blood pressure dropped by 9.0% for those in the intervention group and 2.33% for those in the control group. Similarly, adjusted mean diastolic pressure dropped by 7.42% for the intervention group and remained essentially unchanged for the control group (P = .08) CONCLUSIONS: The findings of this study indicate that walking an extra 30 minutes a day is associated with lower mean blood pressure among adult African Americans with newly diagnosed hypertension.

Use of Point-of-Care Tests (POCTs) by US Primary Care Physicians.

OBJECTIVE: Point-of-care testing (POCT) has been used in the United States for several decades to diagnose and monitor acute and chronic medical conditions. The aim of this study is to assess the use of POCT and perceived benefits of and concerns regarding POCT among US family physicians. METHODS: A total of 405 US family physicians responded to an electronic survey about their use of POCT for diagnosing and monitoring illnesses and for reducing referrals for specialty care. Respondents were also asked about the frequency of, benefits of, and concerns regarding the use of POCT. RESULTS: The top 10 conditions for which physicians reported using POCT for diagnosis are diabetes mellitus, urinary tract infections, strep throat, influenza, pregnancy, anemia, infectious mononucleosis, anticoagulation, acute cardiac conditions, and lipid disorders. More than half of the respondents use or would use >15 kinds of POCTs at least weekly. The perceived benefits of POCT included immediately available results and physician/patient satisfaction; perceived concerns included the accuracy and cost of the tests. CONCLUSIONS: Findings show that a variety of point-of-care tests are used by US family physicians for immediate diagnosis and monitoring. With continuing technical improvements and decreasing costs, it is highly likely that POCT use will increase dramatically.

Primary care of the liver transplant recipient.

Chronic rejection of liver graft is an insidious process. Major immunosuppression medications such as tacrolimus, cyclosporin, and sirolimus have dose-related toxicity and narrow therapeutic windows. Certain drugs can affect metabolism of calcineurin inhibitors. Primary care physicians should be vigilant for any unusual opportunistic infection in liver transplant recipients. The quality of life of liver transplant recipients is an important aspect of care by primary care physicians. Alcohol relapse and possibility of depression in liver transplant recipients should be a continuous concern for primary care physicians. This article provides a guideline for the care of liver transplant recipients.