scholarly journals Effects of Simplified Antihypertensive Treatment Algorithm on Hypertension Management and Hypertension-Related Death in Resource-Constricted Primary Care Setting between 1997 and 2017

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Mulalibieke Heizhati ◽  
Nanfang Li ◽  
Qiaoyan Shi ◽  
Xiaoguang Yao ◽  
Delian Zhang ◽  
...  
Keyword(s):  
Primary Care ◽  
Antihypertensive Treatment ◽  
Treatment Algorithm ◽  
Hypertension Management ◽  
Health Providers ◽  
Treatment Rate ◽  
Cross Sectional ◽  
Primary Care Settings ◽  
Underdeveloped Region ◽  
And Control

Hypertension management is poor in primary care settings of developing countries, where 75% of hypertensives are living. Exploring better ways to improve hypertension management and to decrease stroke and CVD death is needed such as introducing treatment algorithm. Therefore, we selected intervention counties from Xinjiang, an underdeveloped region in China, and introduced antihypertensive treatment algorithm, comprising locally available and affordable agents, to primary health providers since 1998. Program effects were evaluated using the data collected in various ways including cross-sectional screenings to population ≥30 years between 1998 and 2015 by comparing treatment and control rates of hypertension, changes in blood pressure (BP) levels and distribution, and proportion of case/total and NCD death for CVD and stroke. Compared to 1998–2000, treatment rate was improved by 2.78 fold (11.2% vs. 32.1%, P  < 0.001), and the overall and treated control rate were improved by 53.5 fold (0.2% vs. 10.7%, P  < 0.001) and by 16.8 fold (2.0% vs. 33.5%, P  < 0.001), respectively, in 2015. Mean SBP and DBP showed a net reduction by 33.7 mmHg (181.3 vs. 147.6 mmHg) and 21.3 mmHg (106.3 vs. 85.0 mmHg), respectively, in 2015, compared to 1998–2000 ( P  < 0.001), and stage III hypertension was reduced by 75.2% (33.5 vs. 8.3%, P  < 0.001). Compared to 1997–1999, stroke/NCD death was reduced by 34.1% in 2015–2017 (31.7 vs. 20.9%, P  = 0.006) in the intervention counties whereas by 7.5% in control county. Introduction of treatment algorithm helps improve hypertension management and reduce stroke death in resource-constricted primary settings.

scholarly journals Therapeutic Compliance of Patients with Arterial Hypertension in Primary Care

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 631
Author(s):  
Mihaela Adela Iancu ◽  
Irina-Ioana Mateiciuc ◽  
Ana-Maria Alexandra Stanescu ◽  
Dumitru Matei ◽  
Camelia Cristina Diaconu
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Arterial Hypertension ◽  
Antihypertensive Treatment ◽  
Affirmative Answer ◽  
Cross Sectional ◽  
Low Sodium Diet ◽  
Cardiovascular Morbidity And Mortality ◽  
Compliance To Treatment ◽  
And Control

Background and Objectives: Arterial hypertension remains an important cause of cardiovascular morbidity and mortality, despite all the progress made in the methods of diagnosis, monitoring of target organs’ damage and treatment. The main cause of the increased prevalence of uncontrolled blood pressure values is the low compliance to antihypertensive treatment. The objective of our study was to assess the compliance to the treatment of patients diagnosed with arterial hypertension and monitored in a primary care office. Materials and Methods: The cross-sectional, retrospective study included 129 patients, 65.89% (85) women, previously diagnosed with arterial hypertension. Data from the medical files were analyzed, as well as the patients’ answers to a survey of 18 questions regarding arterial hypertension, comorbidities, complications, treatment and awareness of the condition. Results: The study included 129 patients, with a mean age of 66 ± 8 years. The majority of patients were overweight, 55.81% (72 patients), and 10.85% (14 patients) had grade I obesity. Most of the patients, 55.81% (72 patients) were diagnosed with grade III hypertension, while 37.98% (49 patients) were diagnosed with grade II hypertension and 6.2% (8 patients) with grade I hypertension. One third of the surveyed patients answered that they follow the recommendations of a low-sodium diet, 21.7% are adherent to treatment, but 56% think that the total cost of the medication is an impediment for their compliance to treatment. The majority, 82.17% (106 patients), of respondents had an affirmative answer to the questions: ‘Do you think it would be easier to take one pill instead of 2, 3 or 4 pills?’ Conclusion: The increased compliance to the antihypertensive treatment and control of blood pressure values are associated with the degree of awareness of arterial hypertension and the consequences if left untreated, emphasizing the role of the general practitioner in counseling for secondary prevention.

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.

scholarly journals Ten-year trends of hypertension treatment and control rate in Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kwang-il Kim ◽  
Eunjeong Ji ◽  
Jung-yeon Choi ◽  
Sun-wook Kim ◽  
Soyeon Ahn ◽  
...  
Keyword(s):  
Age Groups ◽  
Favorable Effect ◽  
Age Group ◽  
Hypertension Treatment ◽  
Treatment Rate ◽  
Cross Sectional ◽  
The Past ◽  
Nationally Representative ◽  
Multistage Sampling ◽  
And Control

AbstractWe analyzed the Korean National Health and Nutrition Examination Survey (KNHANES) database to determine the trends of hypertension treatment and control rate in Korea over the past 10 years. In addition, we tried to investigate the effect of chronic medical conditions on hypertension management. We investigated the hypertension prevalence, awareness, treatment, and control rate from 2008 to 2017. KNHANES, which uses a stratified multistage sampling design, is a cross-sectional, nationally representative survey conducted by the Korean government. A total of 59,282 adults (≥ 20 years) were included, which was representative of the total population of around 40 million Koreans per year. The mean age was 50.7 ± 16.4 years and 42.6% were male. The prevalence of hypertension, hypercholesterolemia, diabetes mellitus, and obesity significantly increased over the 10 years. During this period, the hypertension treatment and control rate significantly improved. Hypertension treatment rate was significantly lower in the younger age group compared to the older age group, but the control rate among the treated patients was not significantly different between age groups. The treatment and control rates of hypertension were higher in patients with multimorbidity, which implies that it has a favorable effect on the treatment and control of hypertension. Hypertension treatment and control rate have improved over the past 10 years. The higher treatment and control rate in patients with multimorbidity suggest that the more aggressive surveillance might be associated with the improvement of hypertension treatment and control rate in Korea.

Care Coordination for Youth With Mental Health Disorders in Primary Care

2017 ◽  
Vol 57 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Katherine Hobbs Knutson ◽  
Mark J. Meyer ◽  
Nisha Thakrar ◽  
Bradley D. Stein
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Care Coordination ◽  
Child Protective Services ◽  
Mental Health Disorders ◽  
Specialty Care ◽  
Health Providers ◽  
Protective Services ◽  
Primary Care Settings ◽  
Health Disorders

Many children are treated for mental health disorders in primary care settings. The system of care (SOC) provides a framework for collaboration among pediatric mental health providers, but it is unclear if youth treated for mental health disorders in primary care receive such coordination. At the South Boston Community Health Center from September /2012 to August 2013 for 74 individuals ≤18 years, the odds of contact with SOC agencies (mental health, education, child protective services, juvenile justice and developmental disabilities) were compared for mental health treatment in primary versus specialty care. The odds of SOC contact within primary care were lower compared to specialty care (OR = 0.43, 95% CI = 0.29-0.66), specifically for mental health (OR = 0.54, 95% CI = 0.25-1.2), education (OR = 0.12, 95% CI = 0.050-0.28), and child protective services (OR = 0.64, 95% CI = 0.22-1.9). As care coordination may improve health outcomes, increased support and education for care coordination specific to youth treated for mental health disorders in primary care settings may be warranted.

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.

scholarly journals Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
FU Leung Chan ◽  
Yim Chu Li ◽  
Xiao Rui Catherine Chen
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Clinical Practice ◽  
Stepwise Logistic Regression ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Case Register ◽  
Negatively Associated ◽  
Therapeutic Inertia ◽  
Primary Care Settings

Abstract Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

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