scholarly journals Prevalence Rates of Self-Care Behaviors and Related Factors in a Rural Hypertension Population: A Questionnaire Survey

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Huanhuan Hu ◽  
Gang Li ◽  
Takashi Arao
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Physical Exercise ◽  
Self Care ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Health Practitioner ◽  
Care Providers ◽  
Hypertensive Patients ◽  
Diabetes Status

The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.

A 12-Week Evidence-Based Education Project to Reduce Cardiovascular and Metabolic Risk in Adults With Serious Mental Illness in the Integrated Care Setting

2020 ◽  
pp. 107839032090282 ◽  
Author(s):  
Ashley Fenton ◽  
Phyllis Sharps ◽  
Karan Kverno ◽  
Jill RachBeisel ◽  
Marsha Gorth
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Hemoglobin A1c ◽  
Self Care ◽  
Primary Care Providers ◽  
Evidence Based ◽  
Care Providers ◽  
Schizophrenia Spectrum Disorders

BACKGROUND: Individuals with serious mental illness (SMI) such as schizophrenia spectrum disorders, severe bipolar disorder, or severe recurrent major depressive disorder have a shorter life expectancy compared with those in the general population. This is largely due to the higher rates of diabetes, hyperlipidemia, and hypertension. Treatment adherence, diet, exercise, and weight management are modifiable risk factors for these cardiometabolic conditions, yet the use of educational lifestyle interventions is not common practice in the clinical setting. OBJECTIVE: The purpose of this project was to evaluate a 12-week evidence-based diabetes prevention education program integrated into a primary care behavioral health setting for adults with SMI, diabetes, or prediabetes, and who were overweight or obese. STUDY DESIGN: Outcomes for this project included diabetes knowledge, self-care, and health indicators (blood pressure, hemoglobin A1C, weight, body mass index, and medication adherence). The project also addressed feasibility and acceptability of the program in this setting. RESULTS: Project outcomes showed a reduction in weight, waist circumference, hemoglobin A1C, and blood pressure. Outcomes also indicated an improvement in participants’ self-knowledge and self-care. CONCLUSIONS: There was a high attendance rate and overall acceptability and feasibility described by participants. This project highlights the important role that primary care providers can play in providing health education to patients with SMI.

Abstract TP206: The Influence of Contextual Factors on Gaps in Hypertension Management for Veterans with TIA/Minor Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Edward J Miech ◽  
Teresa M Damush ◽  
Ava B Keating ◽  
Gregory W Arling ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Contextual Factors ◽  
Primary Care Providers ◽  
Minor Stroke ◽  
Medical Attention ◽  
Hypertension Management ◽  
Cerebrovascular Event ◽  
Care Providers ◽  
Provider Perspectives

Introduction: Many patients with TIA/minor stroke do not achieve goal blood pressure their cerebrovascular event, thereby remaining at high risk for future events. Understanding the influence of contextual factors associated with post-event hypertension management may inform future intervention studies. Methods: As part of a national, observational study of TIA/minor stroke care across the Veterans Health Administration (VHA), in-person site visits were conducted at participating VHA medical centers in 2014-15. Semi-structured interviews were used to elicit provider perspectives about local practices related to the care of TIA/minor stroke patients. Study team members systematically applied codes transcribed files using qualitative, categorical, and quantitative descriptive codebooks. Investigators used Thematic Content Analysis and mixed-methods matrix displays to analyze coded data, generate, and then validate findings. Results: Seventy interviews were obtained from staff at 14 sites. Several contextual factors appeared to influence post-event hypertension care delivery for patients after a TIA/minor stroke. Neurologists reported that they perceived no direct responsibility for managing post-event blood pressure and were uncertain whether recommendations regarding blood pressure management were being implemented in primary care. Primary care providers expressed hesitancy about titrating antihypertensive medications post-event, citing concerns about permissive hypertension. Providers also reported that poor blood pressure control was not as salient to patients as symptoms, leading some patients to not adhere to their antihypertensives or not feel a sense of urgency in seeking prompt medical attention. VHA facilities did not have protocols to guide providers in the treatment of post-TIA/minor stroke hypertension, with centers expressing little compulsion to develop them. Conclusions: Multiple contextual factors at the provider- and system-levels were identified as barriers to achieving post-cerebrovascular event hypertension control; these data have informed the design of a recently funded vascular risk factor intervention.

scholarly journals Safety Events and Privilege Utilization Rates in Advanced Practice Physical Therapy Compared to Traditional Primary Care: An Observational Study

2019 ◽  
Author(s):  
Lance M Mabry ◽  
Jeffrey P Notestine ◽  
Josef H Moore ◽  
Chris M Bleakley ◽  
Jeffrey B Taylor
Keyword(s):  
Primary Care ◽  
Physical Therapy ◽  
Diagnostic Imaging ◽  
Primary Care Providers ◽  
The United States ◽  
Health Clinic ◽  
Advanced Practice ◽  
Care Providers ◽  
Dry Needling ◽  
Clinical Procedures

Abstract Introduction The general practitioner shortage in the United States coupled with a growing number of Americans living with disability has fueled speculation of non-physician providers assuming a greater role in musculoskeletal healthcare. Previous physician shortages have been similarly addressed, and expanding physical therapy (PT) scope of practice may best serve to fill this need. Resistance to expanding PT practice focuses on patient safety as PTs assume the roles traditionally performed by primary care providers. While studies have shown advanced practice PT to be safe, none have compared safety events in advanced practice PT compared to primary care to determine if there are increased patient risks. Therefore, the purpose of our study is to examine the rate of safety events and utilization of services in an advanced practice PT clinic compared to a primary care clinic. A secondary aim of our study was to report safety events associated with spinal manipulation and dry needling procedures. Materials and Methods Productivity and safety data were retrospectively collected from Malcolm Grow Medical Center from 2015 to 2017 for the Family Health Clinic (FHC) and an advanced practice Physical Therapy Clinic (PTC). Chi-square tests for independence, risk ratios (RR) and 95% confidence intervals (95%) were used to compare the relationship between the frequency of (1) patient encounters and clinical procedures and (2) clinical procedures and safety events. Results Seventy-five percent (12/16) of safety events reported in the PTC were defined as near misses compared to 50% (28/56) within the FHC (RR 1.5; 95% CIs: 1.0 to 2.2). Safety events were more likely to reach patients in the FHC compared to the PTC (RR 1.9; 95% CIs: 0.8 to 4.7). Safety events associated with minor harm to patients was n = 4 and n = 3 in the FHC and PTC respectively. No sentinel events, intentional harm events, nor actual events with more than minor harm were reported in either clinic. Significant relationships indicated that prescriptions, laboratory studies, imaging studies and referrals, were all more likely to be ordered in the FHC than the PTC (p < 0.01). The PTC ordered one diagnostic imaging study for every 37 encounters compared to one in every 5 encounters in the FHC. The PTC similarly referred one patient to another healthcare provider for every 52 encounters, fewer than the one per every 3 encounters in the FHC. There was a significant relationship between encounters and diagnoses, indicating a higher number of diagnoses per encounter in the FHC, though the difference of 0.31 diagnoses per encounter may not be clinically meaningful (p < 0.01). A total of 1,818 thrust manipulations and 2,910 dry needling procedures were completed without any reported safety events. Conclusion These results suggest advanced practice PT has a similar safety profile to primary care. The authority to order musculoskeletal imaging and refer to other clinicians were among the most commonly utilized privileges and may be of primary importance when establishing an advanced practice PT clinic. These results support research showing advanced practice PT may lead to reductions in specialty referrals, diagnostic imaging, and pharmaceutical interventions.

scholarly journals Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers (Preprint)

2018 ◽  
Author(s):  
Sarah Rodriguez ◽  
Kevin Hwang ◽  
Jing Wang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Focus Group ◽  
Care Setting ◽  
Primary Care Setting ◽  
Visual Display ◽  
Primary Care Providers ◽  
Critical Value ◽  
Care Providers ◽  
Home Based

BACKGROUND There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. OBJECTIVE The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. METHODS A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. RESULTS The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. CONCLUSIONS The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes.

scholarly journals Availability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Innocent K. Besigye ◽  
Vicent Okuuny ◽  
Mari Armstrong-Hough ◽  
Anne R. Katahoire ◽  
Nelson K. Sewankambo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Point Of Care ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Health Providers ◽  
Care Providers ◽  
Tororo District ◽  
Key Informant ◽  
Care Facilities

Background: Early diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda.Methods: This was an explanatory sequential mixed-methods study combining a structured facility checklist and key informant interviews with primary care providers. The checklist was used to collect data on availability and functionality of BP machines within their organisational arrangements. Key informant interviews explored health providers’ access to BP machines.Results: The majority of health facilities reported at least one working BP machine. However, Health providers described limited access to machines because they are not located at each point of care. Health providers reported borrowing amongst themselves within their respective units or from other units within the facility. Some health providers purchase and bring their own BP machines to the health facilities or attempted to restore the functionality of broken ones. They are motivated to search the clinic for BP machines for some patients but not others based on their perception of the patient’s risk for hypertension.Conclusion: Access to BP machines at the point of care was limited. This makes hypertension screening selective based on health providers’ perception of the patients’ risk for hypertension. Training in proper BP machine use and regular maintenance will minimise frequent breakdowns.

Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice?

Sexual Health ◽  
2011 ◽  
Vol 8 (1) ◽  
pp. 17 ◽  
Author(s):  
Thomas Shackleton ◽  
Lorna Sutcliffe ◽  
Claudia Estcourt
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Partner Notification ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Sex Partners ◽  
Care Providers ◽  
Practice Nurses ◽  
Limited Effectiveness ◽  
Sexually Transmissible Infections

Background: Partner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmissible infection (STI) management. Innovative partner notification strategies must be relevant to the primary care context. The aim of the present study was to explore the opinions of general practitioners (GP) and practice nurses on the acceptability and feasibility of a new form of partner notification developed in the specialist setting known as Accelerated Partner Therapy (APT), for sex partners of those diagnosed with a bacterial STI in general practice. APT is defined as partner notification strategies that reduce time for sex partners to be treated, and include partner assessment by appropriately qualified health care professionals and here involve telephone and community pharmacy assessment. Methods: Semi-structured qualitative interviews were conducted with a purposive sample of GP and practice nurses in East London, UK. Results: All participants appreciated the importance of partner notification in STI management and felt that APT would improve their practice. They supported prioritising antibiotic provision for the sex partners with provision for future comprehensive STI screening. Although both models were acceptable and feasible, the majority preferred the sexual health clinic telephone assessment over the pharmacy model. Conclusions: GP and practice nurses welcome new strategies for partner notification and believe APT could provide rapid and convenient treatment of sex partners in general practice. This supports further evaluation of APT models as a partner notification strategy in primary care.

scholarly journals P047: Prevalence and severity of hypertension presenting to Calgary area emergency departments

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S73-S73
Author(s):  
K. Eppler ◽  
D. Wang ◽  
T.P. Pollak ◽  
E.S. Lang
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Early Recognition ◽  
Primary Care Providers ◽  
High Risk Population ◽  
Care Providers ◽  
Hypertensive Urgency

Introduction: Hypertension is common and a major cause of morbidity and mortality. Because it is asymptomatic, its diagnosis is often delayed. For many Canadians the Emergency Department (ED) is the only point of entry to the health care system, and therefore the recognition of undiagnosed and untreated hypertension in the ED is increasingly important. This study sought to evaluate the prevalence and severity of hypertension in patients presenting to Calgary area EDs, as well as to determine whether medical therapy was initiated and if patients had primary care providers for follow-up. Methods: Multi-centre electronic medical record (EMR) review of all adult patients presenting to Calgary area EDs from January 1, 2016 to December 31st, 2016. Hypertension was coded electronically by triage nurses and defined as systolic blood pressure SBP 140 mmHg and/or diastolic blood pressure DBP 90 mmHg. Hypertensive urgency was defined as SBP 180 mmHg and/or DBP 120 mmHg. Descriptive data was used to show patient demographics and hypertension prevalence. Primary care provider status, previous diagnosis of hypertension, chief complaint, and ED diagnoses were extracted and the EMRs were manually searched to determine whether treatment was initiated in the ED. Results: Of 304392 patients presenting to all Calgary sites, 43055 (14%) were found to have hypertension; mean age 52 (range 18 to 104), female 42%. Of these, 32986 (77%) had no known previous hypertension and 31% lacked a primary care provider. 0.2% had documentation of treatment initiated in the ED. 16% met criteria for hypertensive urgency. Conclusion: Many patients presenting to the ED have hypertension, often previously undiagnosed and at times severe. Many lack access to primary care. EDs may play an important role in the early recognition of hypertension. Dedicated management and follow-up pathways are indicated for this high-risk population.

scholarly journals Hepatitis C Treatment at a Rural Navajo Health Clinic Using Project ECHO

2020 ◽  
Vol 20 (2) ◽  
pp. 133-155
Author(s):  
Anna R Nance ◽  
Lori S Saiki ◽  
Elizabeth G Kuchler ◽  
Conni DeBlieck ◽  
Susan Forster-Cox
Keyword(s):  
Primary Care ◽  
Chronic Hepatitis ◽  
Quality Improvement ◽  
Hepatitis C ◽  
Primary Care Providers ◽  
Health Clinic ◽  
Care Providers ◽  
Hepatitis C Treatment ◽  
Improvement Project ◽  
Project Echo

Purpose: Hepatitis C incidence is higher among American Indian/Alaskan Native populations than any other racial or ethnic group in the United States. Chronic Hepatitis C complications include cirrhosis of the liver, end stage liver disease, and hepatocellular cancer. Direct acting antiviral treatment taken orally results in > 90% cure, yet rural primary care providers lack the training and confidence to treat and monitor patients with chronic Hepatitis C. Rural patients are reluctant to travel to urban areas for Hepatitis C treatment. Project ECHO is an innovative tele-mentoring program where specialists mentor primary care providers via videoconferencing to treat diseases they would otherwise be unable to manage. The purpose of this quality improvement project was to increase Hepatitis C treatment at a rural Navajo health clinic through partnership with Project ECHO specialists. Methods: This quality improvement project was guided by Lippitt’s Phases of Change Theory. The systematic process plan included a protocol for roles and expectations of all members of the healthcare team, a documentation and communication plan, and a tracking system for monitoring patient progress through the plan of care. Outcomes were analyzed by descriptive statistics. Findings: Following partnership with Project ECHO, six patients (31.6%) consented to receiving Hepatitis C treatment at the rural Navajo health clinic. All six were contacted by outreach staff at multiple points during the project. Five (26.3%) completed the full course of drug therapy. Four (21.1%) completed follow-up lab work, of which three (15.8%) had a documented cure by sustained virologic response. Conclusions: Hepatitis C care via Project ECHO-rural clinic partnership was affordable, feasible and not excessively time consuming for a facility with substantial patient outreach resources. Key words: Rural health clinic, Hepatitis C, Project ECHO, tele-mentoring, Native American

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