scholarly journals Government-Expert Joint Intervention with Treatment Algorithm and Improved Hypertension Management and Reduced Stroke Mortality in a Primary-Care Setting

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Mulalibieke Heizhati ◽  
Nanfang Li ◽  
Delian Zhang ◽  
Suofeiya Abulikemu ◽  
Guijuan Chang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Treatment Algorithm ◽  
Primary Care Providers ◽  
Hypertension Management ◽  
Stroke Mortality ◽  
Hypertension Awareness ◽  
And Control

Hypertension management is suboptimal in the primary-care setting of developing countries, where the burden of both hypertension and cardiovascular disease is huge. Therefore, we conducted a government-expert joint intervention in a resource-constrained primary setting of Emin, China, between 2014 and 2016, to improve hypertension management and reduce hypertension-related hospitalization and mortality. Primary-care providers were trained on treatment algorithm and physicians for specialized management. Public education was delivered by various ways including door-to-door screening. Program effectiveness was evaluated using screening data by comparing hypertension awareness, treatment, and control rates and by comparing hypertension-related hospitalization and total cardiovascular disease (CVD) and stroke mortality at each phase. As results, 313 primary-health providers were trained to use the algorithm and 3 physicians attended specialist training. 1/3 of locals (49490 of 133376) were screened. Compared to the early phase, hypertension awareness improved by 9.3% (58% vs. 64%), treatment by 11.4% (39% vs. 44%), and control rates by 33% (10% vs. 15%). The proportion of case/all-cause hospitalization was reduced by 35% (4.02% vs. 2.60%) for CVD and by 17% (3.72% vs. 3.10%) for stroke. The proportion of stroke/all-cause death was reduced by 46% (21.9% in 2011–2013 vs. 15.0% in 2014–2016). At the control area, the proportion of case/all-cause mortality showed no reduction. In conclusion, government-expert joint intervention with introducing treatment algorithm may improve hypertension control and decrease related hospitalization and stroke mortality in underresourced settings.

Increased Cardiovascular Disease in Patients with Inflammatory Arthritis in Primary Care: A Cross-sectional Observation: Table 1.

2009 ◽  
Vol 36 (9) ◽  
pp. 1866-1868 ◽  
Author(s):  
MIKE J.L. PETERS ◽  
MARK M.J. NIELEN ◽  
HENNIE G. RATERMAN ◽  
ROBERT A. VERHEIJ ◽  
FRANCOIS G. SCHELLEVIS ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Inflammatory Arthritis ◽  
Care Setting ◽  
Primary Care Setting ◽  
Conditional Logistic Regression ◽  
Regression Analyses ◽  
Cross Sectional ◽  
Cardiovascular Risk Management ◽  
And Control

Objective.To compare the prevalence of cardiovascular disease (CVD) in patients with inflammatory arthritis and control subjects registered in primary care.Methods.Conditional logistic regression analyses were used to compare the CVD prevalence in patients and controls, aged 50–75 years.Results.Overall, the CVD prevalence was 66.1 per 1000 patients in inflammatory arthritis and 37.3 per 1000 patients in controls, resulting in an odds ratio of 1.83 (95% confidence interval 1.33–2.51).Conclusion.Inflammatory arthritis patients registered in primary care are associated with an increased cardiovascular burden, which emphasizes the need for cardiovascular risk management in the primary care setting.

Primary prevention of cardiovascular disease in a primary care setting

2015 ◽  
Vol 17 (03) ◽  
pp. 311-316
Author(s):  
Linda Tahaineh ◽  
Suhad Barakat ◽  
Abla M. Albsoul-Younes ◽  
Ola Khalifeh
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Primary Prevention ◽  
Care Setting ◽  
Primary Care Setting ◽  
And Control ◽  
Measurement And Control ◽  
Prevention Of Cardiovascular Disease

AimThis study was designed to investigate primary prevention of cardiovascular disease in a primary care setting in Jordan.MethodsAdult patients without clinical cardiovascular disease who attended a primary care setting were interviewed and their medical files were reviewed. Data collected to assess primary prevention of cardiovascular disease included lifestyle/risk factor screening, weight assessment, blood pressure measurement and control, and blood lipid measurement and control.ResultsA total of 224 patients were interviewed. The proportions of patients’ files with risk factors documentation were 37.9% for smoking status, 30.4% for physical activity assessment and 72.8% for blood pressure assessment. The majority of hypertensive patients (95.9%) had a blood pressure reading at their most recent visit of ⩽140/90 or was prescribed ⩾2 antihypertensive medications.ConclusionDocumentation of cardiovascular disease risk factors was suboptimal. Healthcare providers should be encouraged to document and assess cardiovascular risk factors to improve primary prevention.

scholarly journals Engaging primary care providers in managing pediatric eating disorders: a mixed methods study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Disorders ◽  
Mixed Methods ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mixed Methods Study ◽  
Evidence Based ◽  
Care Providers ◽  
Evidence Based Treatment

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.

Abstract P720: Primary Stroke Prevention by Primary Care Providers: An Unmet Need

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raymond Reichwein ◽  
Alicia Richardson ◽  
Cesar Velasco
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Primary Prevention ◽  
Care Setting ◽  
Stroke Risk ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Large Vessel ◽  
Care Providers ◽  
Stroke Risk Factors

Introduction: The majority of patients who present with acute ischemic stroke (AIS) have known stroke risk factors which are not optimally managed. It has been suggested that a CHADS-VASC score can assist with primary prevention by calculating future stroke risk. This however, has not been widely adapted in the primary care setting. Methods: From 2018-2019, 686 AIS patients were included in retrospective analysis. Data elements included: historical stroke risk factors, historical CHADS-VASC score, antiplatelet/anticoagulant use at time of presentation, discharge location, and mRS. Results: Of the 686 AIS patients, 77% were age > 60, and 52% were male. Etiology subtypes were small vessel/lacunar 20%, large vessel 22%, cardioembolic 20%, undetermined 31% (cryptogenic 15%), and other determined 5%. On presentation, the majority of patients had 2 or more stroke risk factors and a calculated historical CHADS-VASC score > 2 (Table 1). Over half of the patients with large vessel or small vessel/lacunar etiology were not on any antiplatelets and 53% of patients with known history of atrial fibrillation weren’t on anticoagulants. Forty-nine percent of patients had a mRS > 3 at discharge. Conclusion: Patients with several stroke risk factors are sub optimally managed by primary care providers. Primary prevention education for PCPs in management of higher stroke risk individuals and additional analysis of the CHADS-VASC tool for this setting is needed. If widely adapted, this tool may prevent strokes by providing adequate risk reduction in the primary care setting.

scholarly journals Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting

2020 ◽  
Vol 38 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Rebecca M. Crimmins ◽  
Lydia Elliott ◽  
Darren T. Absher
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Palliative Care ◽  
Patient Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Cochrane Library ◽  
Care Providers ◽  
Communication Time

Context: Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. Objectives: The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. Methods: An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. Results: Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. Conclusion: The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.

The Implementation of a Clinical Toolkit and Adolescent Depression Screening Program in Primary Care

2014 ◽  
Vol 53 (14) ◽  
pp. 1336-1344
Author(s):  
Jonathan M. Libby ◽  
Eileen Stuart-Shor ◽  
Almas Patankar
Keyword(s):  
Primary Care ◽  
Adolescent Depression ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Program ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Care Providers ◽  
Comfort Levels ◽  
Survey Results

Problem/Background. Adolescent depression is a growing problem for today’s society with only 30% receiving services. Aim and Methods. The aim of this project was to increase identification and treatment of depressed adolescents, and comfort levels of primary care providers with the implementation of a depression-screening program and use of a clinical depression toolkit within a primary care setting. Setting. The setting was a private pediatric practice in central Maine. Results. Over an 8-week period, 266 adolescents were screened. Twelve adolescents (4.5%) received a diagnosis of depression and 11 received treatment within 8 days. Survey results showed a significant increase in providers’ feelings of comfort and accountability. Conclusion. This project demonstrates that it is feasible to implement a depression screening and treatment program in primary care. It demonstrates that primary care providers can increase their comfort and feelings accountability in treating depression in primary care, thus increasing access for this monumental and potential catastrophic problem.

SAT0320 High frequency of cardiovascular disease in patients with knee osteoarthritis in a primary care setting:

2013 ◽  
Vol 71 (Suppl 3) ◽  
pp. 580.2-580
Author(s):  
N. Navarro ◽  
C. Orellana ◽  
I. Vázquez ◽  
E. Casado ◽  
J. Gratacόs ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Knee Osteoarthritis ◽  
High Frequency ◽  
Care Setting ◽  
Primary Care Setting
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