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1.
Am J Hypertens ; 36(12): 667-676, 2023 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-37639217

RESUMO

BACKGROUND: Uncontrolled hypertension significantly increases risk of cardiovascular disease and death. This study examined the prevalence of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis and factors associated with these outcomes in a real-world patient cohort. METHODS: Electronic medical records from a large healthcare system in North Carolina were used to identify adults with uncontrolled hypertension (last ambulatory blood pressure [BP] measurement ≥140/90); persistently uncontrolled hypertension (≥2 ambulatory BP measurements with all readings ≥140/90); and hypertensive crisis (any BP reading ≥180/120) in 2019. Generalized linear mixed models tested the association between patient and provider characteristics and each outcome. RESULTS: The study cohort included 213,836 patients (mean age 63.1 (±14.0) years, 55.5% female, 70.8% white). Of these, 29.7% and 13.1% had uncontrolled hypertension and hypertensive crisis, respectively. Among those experiencing hypertensive crisis, >50% did not have uncontrolled hypertension. Of the 171,061 patients with ≥2 BP measurements, 5.9% had persistently uncontrolled hypertension. The likelihood of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis was higher in patients with black race (vs. white), self-pay (vs. private), prior emergency room visit, and no attributed primary care provider. Readings taken in the evening (vs. morning) and at specialty (vs. primary care) practices were more likely to meet thresholds for uncontrolled hypertension and hypertensive crisis. CONCLUSIONS: Hypertension control remains a significant challenge in healthcare. Health systems may benefit from segmenting their patient population based on factors such as race, prior healthcare use, and timing of BP measurement to prioritize outreach and intervention.


Assuntos
Doenças Cardiovasculares , Hipertensão , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Monitorização Ambulatorial da Pressão Arterial , Prevalência , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Doenças Cardiovasculares/tratamento farmacológico , Atenção à Saúde , Pressão Sanguínea , Anti-Hipertensivos/uso terapêutico
2.
J Nurs Adm ; 45(1): 7-10, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25479169

RESUMO

With a recent decrease in community resources for the mental health population, acute care facilities must seek creative, cost-effective ways to protect and care for these vulnerable individuals. This article describes 1 facility's journey to maintaining patient and staff safety while reducing cost. Success factors of this program include staff engagement, environmental modifications, and a nurse-driven, sitter-reduction process.


Assuntos
Tratamento de Emergência/economia , Liderança , Transtornos Mentais/enfermagem , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Gestão da Segurança/organização & administração , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Papel do Profissional de Enfermagem , Inovação Organizacional , Equipe de Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Gestão da Segurança/economia , Estados Unidos
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