The Use of Telemedicine to Improve Hypertension in an Urban Primary Care Clinic and Predictors of Improved Blood Pressure.

BACKGROUND AND OBJECTIVE: Meta-analysis of randomized controlled trials have demonstrated the efficacy of telemedicine in blood pressure (BP) management when compared to conventional care. We initiated a hypertension telehealth clinic in our urban primary care clinic and through this study aim to evaluate the strengths and limitations of telemedicine in hypertension (HTN) control. The primary outcome of the study is to identify the proportion of patients with improved HTN. Secondary outcomes included identifying: predictors for lower BP, predictors of missing telehealth appointments, and comorbid conditions that are more likely to necessitate use of more than 1 antihypertensive medication. METHODS AND ANALYSIS: Patients seen in the HTN telehealth clinic from May 1st, 2022 to October 31st, 2022 were identified. A retrospective chart review was done to compare the BP during in-person visit prior to first telehealth visit, telehealth visit home BP readings and last recorded in-office BP on chart at end of study period. Descriptive statistical analysis, Chi Square test, and multivariable logistic regression was used to analyze data. RESULTS: Of the 234 appointments, 83% were conducted and 154 patients were seen. A remarkable decrease in percentage of patients with BP >140/90 was seen when comparing in-office visit BP to first telehealth visit home BP, 72% versus 45% respectively. No remarkable difference was noted in percentage of patients with BP >140/90 when comparing first telehealth visit home BP to last in-office BP recorded on chart, 45% and 41% respectively. Patients with diabetes had lower odds of missing appointments, adjusted odds ratio (aOR): 0.34 ([0.12-0.91], P = .03). Patients with partners were more likely to have lower BP at the telehealth visit, aOR:3.2 ([1.15-9.86], P = .03) while patients with obstructive sleep apnea (OSA) (aOR 0.27 ([0.08-0.77], P = .02) and CAD, aOR 0.24 ([0.06-0.8], P = .03) were less likely to have lower BP. CONCLUSION: The study demonstrated telemedicine as a great tool to prevent overtreatment of hypertension as significant difference between in-office BP and home BP during telehealth visits was noted. We did not see a significant change in blood pressure when comparing home BP at first telehealth visit to the last in-person clinic BP at end of study period.

In the minority: black physicians in residency and their experiences.

OBJECTIVE: To describe black residents' perceptions of the impact of race on medical training. MATERIALS AND METHODS: Open-ended interviews were conducted of black physicians in postgraduate year 22 who had graduated from U.S. medical schools and were enrolled in residency programs at one medical school. Using Grounded Theory tenets of qualitative research, data was culled for common themes through repeated readings; later, participants commented on themes from earlier interviews. RESULTS: Of 19 participants 10 were male, distributed evenly among medical and surgical fields. Four major themes emerged from the narratives: discrimination, differing expectations, social isolation and consequences. Participants' sense of being a highly visible minority permeated each theme. Overt discrimination was rare. Participants perceived blacks to be punished more harshly for the same transgression and expected to perform at lower levels than white counterparts. Participants' suspicion of racism as a motivation for individual and institutional behaviors was tempered by self-doubt. Social isolation from participants' white colleagues contrasted with connections experienced with black physicians, support staff and patients, and participants strongly desired black mentors. Consequences of these experiences varied greatly. CONCLUSIONS: Black physicians face complex social and emotional challenges during postgraduate training. Creating supportive networks and raising awareness of these issues may improve training experiences for black physicians.