Primary Care Providers' Recommendations for Hypertension Prevention, DocStyles Survey, 2012

When and why US primary care providers do and do not refer their patients with new-onset seizures or existing epilepsy or seizure disorders to neurologists-2018 DocStyles

Monitoring primary care providers' (PCP) attitudes and experiences with referrals of their patients with new-onset seizures or existing epilepsy/seizure disorders may help evaluate whether interventions to coordinate PCP and neurology care reduce treatment gaps and improve patient outcomes. To examine PCPs' attitudes toward, and experiences with, referral to specialty care of their patients with new-onset seizures or existing epilepsy/seizure disorders, we used cross-sectional 2018 DocStyles data to examine study outcomes. We selected a subsample of respondents who had a practice with at least 1% of patients with an epilepsy/seizure disorder and who answered questions about this disorder. We stratified provider actions, referral behavior, and referral enabling factors and barriers by epilepsy/seizure disorder caseload and provider type. We examined different patterns of responses by referral behavior and provider type. The final sample (n = 1284) included 422 family practitioners, 432 internists, 233 pediatricians, and 197 nurse practitioners. Most PCPs refer their patients with new-onset seizures to a neurologist, particularly to determine or confirm the diagnosis and appropriate treatment. Strikingly, about 40% of PCPs did not indicate a referral if their epilepsy/seizure disorder patient was unresponsive to treatment. Internists less likely referred their patients than pediatricians, nurse practitioners, or family practitioners. Less than one-third of all practitioners consulted seizure treatment guidelines. Prompt appointments, communication with the PCP, the patient's insurance, and referral back to primary care may facilitate referrals. Interventions that enhance enabling factors for guidelines-based care and that can increase opportunities for PCPs to consult with neurologists and/or refer their patients with uncontrolled seizures to specialty care are warranted.

Partnerships for Blood Pressure Control in Washington State, December 2016-July 2017

According to recent guidelines, 46% of U.S. adults have high blood pressure (i.e., hypertension). Traditionally addressed in clinical settings, only 54% of adults successfully manage their hypertension. Community-clinical partnerships that facilitate medication adherence and lifestyle changes are promising avenues to achieve population-level blood pressure control. We examined partnerships for blood pressure control in Washington State, their facilitators and barriers, and ways public health departments could foster partnerships. We conducted 41 semistructured interviews with clinic staff, community-based organization (CBO) staff, pharmacy staff, and community health workers (CHWs). The Centers for Disease Control and Prevention-adapted Himmelman Collaboration Continuum, which describes five levels of partnership intensity, guided our thematic analysis. We found variation across sectors in partnership frequency and intensity. Clinic and pharmacy staff reported fewer partnerships than CBO staff and CHWs, and mostly either low or very high intensity partnerships. CBO staff and CHWs described partnerships at each intensity level. Trust and having a shared mission facilitated partnerships. Competition, lack of time, limited awareness of resources, and lack of shared health records constituted barriers to partnership. Bringing potential partners together to discuss shared goals, increasing technological integration, and building awareness of resources may help bridge clinical and community silos and improve population-level blood pressure control.

Priority community engagement strategies for cardiovascular health: A checklist for community pharmacists

OBJECTIVE

The objective of this study was to identify essential strategies for use by community pharmacists seeking to establish community partnerships to prevent and manage cardiovascular disease (CVD) in their local communities.

METHODS

A multistep process was used to develop and refine the Community-Clinical Linkages for Cardiovascular Health (CCL-CVD) checklist. First, the authors reviewed the extant literature related to community pharmacists' community engagement and identified evidence-based recommendations for community pharmacists from the Centers for Disease Control and Prevention's guidance documents and linkage framework. Next, the authors developed a 9-item checklist of community engagement strategies for use by practicing community pharmacists with an interest in health promotion and partnership development. The authors then surveyed 15 content experts from across the United States and asked them to evaluate each of the 9 checklist items on a 3-point scale: (1) essential; (2) useful, but not essential; or (3) not necessary. On the basis of the survey results, the authors calculated a content validity ratio (CVR) for each of the 9 strategies and performed a content analysis of the qualitative responses provided by the content experts.

RESULTS

Eleven content experts completed the survey for a response rate of 73%. The CVR for 3 strategies from the initial CCL-CVD checklist reached statistical significance, and these 3 strategies were considered essential strategies for community pharmacists to use when working to develop community partnerships to improve CVD. The following strategies were considered essential: (1) gathering data to support the need for pharmacists' services, (2) identifying preferred communication strategies, and (3) creating mechanisms for documentation and establishing an evaluation plan. An additional strategy-develop goals and objectives for the partnership-neared statistical significance and was included as a second-tier strategy.

CONCLUSION

The multistep process resulted in a practical, 2-tiered checklist for use by community pharmacists who are interested in community engagement and developing sustainable CCLs to improve CVD health.

Prevalence and incidence of hyponatremia and their association with diuretic therapy: Results from North India

Introduction:

Hyponatremia is associated with substantial morbidity and mortality. Correct estimation of their prevalence, incidence and risk factors, especially the diuretics in Indian patients is important in determining preventive strategies.

Methods:

This multistage mixed methods-based study was conducted in a high-volume cardiac care center to ensure the correct estimation. Patients receiving oral diuretics on an outpatient basis and those admitted to hospital for hyponatremia were enrolled.

Results:

The prevalence of hyponatremia was 27% while the incidence rate was 18% and 29% after 3- and 6-month of the diuretic therapy. The highest rates of hyponatremia were observed in warm season (45%, 111 in 247 patients). Multivariate logistic regression analysis revealed that low solute and nutritious intake and edematous state were negatively correlated with serum sodium levels. Neither diarrhea/vomiting nor diuretic use were found to be associated with hyponatremia.

Conclusions:

Diuretics use was not associated with hyponatremia in adults in this population cohort. However, elderly people on diuretics are comparatively more likely to have hyponatremia. However, a randomized parallel arm trial comparing diuretics with other antihypertensives be done to establish whether diuretics are associated with hyponatremia in this patient population.

Quality of hypertension care: An improvement initiative in two outpatient health care centers

RATIONALE, AIMS, AND OBJECTIVES

Hypertension control is an important public health goal; however, significant barriers remain in primary care practice. Our objective was to identify areas for improvement in hypertension care and implement changes in management to improve outcomes. We also aimed to evaluate whether quality improvement influences physician attitudes towards and adherence to current hypertension guidelines.

METHOD

We conducted a non-experimental pre- vs post- design quality improvement study for ambulatory patients with a history of hypertension. Specific measures of hypertension care were assessed at baseline and 3 months post-implementation of the quality improvement initiative. De-identified data were collected from 100 charts, randomly selected from the practice's electronic medical records, and compared with a national sample of peer data. The Intervention was based on the American Academy of Family Physicians METRIC Performance Improvement module. This consisted of creating a computerized registry, system improvements to the electronic medical records, and peer education workshops on best practices. A 7-item survey was completed by primary care physicians pre- and post-intervention.

RESULTS

Improvement was demonstrated in several primary outcome measures: increased number of patients counselled on sodium intake (P = 0.005), physical activity (P = 0.001), alcohol consumption (P = 0.03), and weight reduction (P < 0.0001). Practice self-assessment findings did not show a statistically significant change following the intervention.

CONCLUSIONS

This quality improvement increased provider compliance with hypertension guidelines. However, more effort is required to modify physician practices for full compliance with the 2017 updated hypertension guidelines.

Barriers to implement screening for alcohol consumption in Spanish hypertensive patients

BACKGROUND

Alcohol intake and hypertension (HT) are interrelated public health problems with cost-effective interventions at the primary care level that, to date, are poorly implemented.

OBJECTIVE

This study aims to explore the barriers to implementing alcohol interventions for people with HT in primary care.

METHODS

As part of the project BASIS (Baseline Alcohol Screening and Intervention Survey), an internet survey from five European countries was developed to determine the role of alcohol in the management of HT in primary care practice. The survey contained 28 core items and 7 country-specific items. We present answers from Spanish general practitioners (GPs), who were reached through the main professional and scientific societies via e-mail and asked to take the online survey.

RESULTS

In total, 867 GPs answered the survey (65.1% women, 70.4% > 30 years old). As indicated by the Alcohol Use Disorders Identification Test-C scores, 12.4% of GPs who responded were risky drinkers (21.3% of men versus 7.1% of women). GPs reported considering alcohol relatively unimportant in HT treatment, as well as a difficult condition to deal with. The three main barriers to implement screening for alcohol consumption in HT patients were the lack of time (50.0%), considering alcohol unimportant for HT (28.4%) and stigma (16.5%).

CONCLUSIONS

GPs did not consider alcohol consumption a relevant factor for HT and, additionally, found it difficult to deal with alcohol problems. Some of the barriers for alcohol screening could be overcome through structural changes in the health system, such as empowering GPs to treat alcohol use disorders (rather than a single focus on implementing preventive strategies) by enhancing training in alcohol diagnosis and treatment.