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Sharpe CM, Eastham L. Team-Based Care Model Improves Timely Access to Care and Patient Satisfaction in General Cardiology. J Healthc Qual 2024; 46:72-80. [PMID: 38421905 DOI: 10.1097/jhq.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
ABSTRACT Appointment wait times have increased nationally since 2014, especially in cardiology. At a mid-Atlantic academic medical center, access to care in the general cardiology clinic was below national standards, which can negatively affect patient outcomes and satisfaction. Adopting a team-based care (TBC) model, advanced practice providers (APPs) were added to care teams with general cardiologists to provide timely outpatient management of cardiac conditions. This aimed to increase access to care and, consequently, patient satisfaction. A formative program evaluation using the Agency for Clinical Innovation framework assessed TBC's impact on these outcomes. Access to care and patient satisfaction measures for TBC and nonteam providers were compared with one another and national benchmarks. Nine months after implementation, the average time to new patient appointment for TBC providers was 31 days (47% decrease) and for nonteam providers was 41 days (20% decrease). TBC had a higher percentage of new patient appointments within 14 days than nonteam providers (39% and 20%, respectively). Patient satisfaction improved to the 98th percentile nationally for TBC but decreased to the 71st percentile for nonteam. These findings suggest that a TBC model using APPs can improve access to care and patient satisfaction in the outpatient general cardiology setting.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 110] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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3
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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4
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Beavers CJ, Jurgens CY. Best Practice: Using Pharmacist- and Nurse-Led Optimization in Heart Failure to Achieve Guideline-directed Medical Therapy Goals. J Card Fail 2023; 29:1014-1016. [PMID: 37236501 DOI: 10.1016/j.cardfail.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Craig J Beavers
- University of Kentucky College of Pharmacy, Lexington, Kentucky.
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Kittleson MM, Panjrath GS, Amancherla K, Davis LL, Deswal A, Dixon DL, Januzzi JL, Yancy CW. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2023; 81:1835-1878. [PMID: 37137593 DOI: 10.1016/j.jacc.2023.03.393] [Citation(s) in RCA: 68] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Yu X, Li YT, Cheng H, Zhu S, Hu XJ, Wang JJ, Mohammed BH, Xie YJ, Hernandez J, Wu HF, Wang HHX. Longitudinal changes in blood pressure and fasting plasma glucose among 5,398 primary care patients with concomitant hypertension and diabetes: An observational study and implications for community-based cardiovascular prevention. Front Cardiovasc Med 2023; 10:1120543. [PMID: 37077741 PMCID: PMC10106827 DOI: 10.3389/fcvm.2023.1120543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
AimsTo assess longitudinal changes in blood pressure (BP) and fasting plasma glucose (FPG) in primary care patients with concomitant hypertension and type 2 diabetes mellitus (T2DM), and to explore factors associated with patients' inability to improve BP and FPG at follow-up.MethodsWe constructed a closed cohort in the context of the national basic public health (BPH) service provision in an urbanised township in southern China. Primary care patients who had concomitant hypertension and T2DM were retrospectively followed up from 2016 to 2019. Data were retrieved electronically from the computerised BPH platform. Patient-level risk factors were explored using multivariable logistic regression analysis.ResultsWe included 5,398 patients (mean age 66 years; range 28.9 to 96.1 years). At baseline, almost half [48.3% (2,608/5,398)] of patients had uncontrolled BP or FPG. During follow-up, more than one-fourth [27.2% (1,467/5,398)] of patients had no improvement in both BP and FPG. Among all patients, we observed significant increases in systolic BP [2.31 mmHg, 95% confidence interval (CI): 2.04 to 2.59, p < 0.001], diastolic BP (0.73 mmHg, 0.54 to 0.92, p < 0.001), and FPG (0.12 mmol/l, 0.09 to 0.15, p < 0.001) at follow-up compared to baseline. In addition to changes in body mass index [adjusted odds ratio (aOR)=1.045, 1.003 to 1.089, p = 0.037], poor adherence to lifestyle advice (aOR = 1.548, 1.356 to 1.766, p < 0.001), and unwillingness to actively enrol in health-care plans managed by the family doctor team (aOR = 1.379, 1.128 to 1.685, p = 0.001) were factors associated with no improvement in BP and FPG at follow-up.ConclusionA suboptimal control of BP and FPG remains an ongoing challenge to primary care patients with concomitant hypertension and T2DM in real-world community settings. Tailored actions aiming to improve patients' adherence to healthy lifestyles, expand the delivery of team-based care, and encourage weight control should be incorporated into routine healthcare planning for community-based cardiovascular prevention.
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Affiliation(s)
- Xiao Yu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yu Ting Li
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Hui Cheng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Xiu-Jing Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jia Ji Wang
- Centre for General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
- Guangdong-provincial Primary Healthcare Association, Guangzhou, China
| | - Bedru H. Mohammed
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Hua-Feng Wu
- Shishan Community Health Centre of Nanhai, Foshan, China
- Correspondence: Harry H.X. Wang Hua-Feng Wu
| | - Harry H. X. Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- Usher Institute, Deanery of Molecular, Genetic & Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Correspondence: Harry H.X. Wang Hua-Feng Wu
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Butel-Simoes LE, Haw TJ, Williams T, Sritharan S, Gadre P, Herrmann SM, Herrmann J, Ngo DTM, Sverdlov AL. Established and Emerging Cancer Therapies and Cardiovascular System: Focus on Hypertension-Mechanisms and Mitigation. Hypertension 2023; 80:685-710. [PMID: 36756872 PMCID: PMC10023512 DOI: 10.1161/hypertensionaha.122.17947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Cardiovascular disease and cancer are 2 of the leading causes of death worldwide. Although improvements in outcomes have been noted for both disease entities, the success of cancer therapies has come at the cost of at times very impactful adverse events such as cardiovascular events. Hypertension has been noted as both, a side effect as well as a risk factor for the cardiotoxicity of cancer therapies. Some of these dynamics are in keeping with the role of hypertension as a cardiovascular risk factor not only for heart failure, but also for the development of coronary and cerebrovascular disease, and kidney disease and its association with a higher morbidity and mortality overall. Other aspects such as the molecular mechanisms underlying the amplification of acute and long-term cardiotoxicity risk of anthracyclines and increase in blood pressure with various cancer therapeutics remain to be elucidated. In this review, we cover the latest clinical data regarding the risk of hypertension across a spectrum of novel anticancer therapies as well as the underlying known or postulated pathophysiological mechanisms. Furthermore, we review the acute and long-term implications for the amplification of the development of cardiotoxicity with drugs not commonly associated with hypertension such as anthracyclines. An outline of management strategies, including pharmacological and lifestyle interventions as well as models of care aimed to facilitate early detection and more timely management of hypertension in patients with cancer and survivors concludes this review, which overall aims to improve both cardiovascular and cancer-specific outcomes.
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Affiliation(s)
- Lloyd E Butel-Simoes
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
- College of Health and Medicine, University of Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Tatt Jhong Haw
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Trent Williams
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Shanathan Sritharan
- Department of Medicine, Hunter New England Local Health District, NSW, Australia
| | - Payal Gadre
- Department of Medicine, Hunter New England Local Health District, NSW, Australia
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA
| | - Doan TM Ngo
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Aaron L Sverdlov
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
- College of Health and Medicine, University of Newcastle, NSW Australia
- Newcastle Centre of Excellence in Cardio-Oncology, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
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8
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Hittle Gigli K, Barnes H. Letter to the Editor In Response to: "Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners" (Suh et al. 2022). Pediatr Cardiol 2023; 44:263-264. [PMID: 36376477 DOI: 10.1007/s00246-022-03047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
The authors present a Letter to the Editor in response to the recently published article: "Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners" by Suh et al. (Pediatr Cardiol, https://doi.org/10.1007/s00246-022-02959-0 , 2022).
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Affiliation(s)
| | - Hilary Barnes
- Widener University School of Nursing, Chester, PA, 19013, USA.
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Composition of An Ideal Medical Care Team. Dela J Public Health 2022; 8:150-153. [PMID: 36751608 PMCID: PMC9894047 DOI: 10.32481/djph.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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10
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Rosner CM, Lee SB, Badrish N, Maini AS, Young KD, Vorgang CM, Bagnola A, Desai SS, Hahndorf C, Looby M, Psotka MA, O'Connor CM, Cooper LB. Advanced Practice Provider Urgent Outpatient Clinic for Patients With Decompensated Heart Failure. J Card Fail 2022; 29:536-539. [PMID: 36526217 DOI: 10.1016/j.cardfail.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Seiyon Ben Lee
- Department of Statistics, George Mason University, Fairfax, Virginia
| | | | - Aneel S Maini
- Georgetown University Medical School, Washington, D.C
| | - Karl D Young
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Aaron Bagnola
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Mary Looby
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Lauren B Cooper
- Inova Heart and Vascular Institute, Falls Church, Virginia; Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York
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Walsh MN, Arrighi JA, Cacchione JG, Chamis AL, Douglas PS, Duvernoy CS, Foody JM, Hayes SN, Itchhaporia D, Parmacek MS, Stefanescu Schmidt AC, Vetrovec GW, Waites TF, Warner JJ. 2022 ACC Health Policy Statement on Career Flexibility in Cardiology: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022; 80:2135-2155. [PMID: 36244862 DOI: 10.1016/j.jacc.2022.08.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Lerch W, Williams K, Polak C, Rometo A, Comunale MJ, Reynolds B. Establishment of Pediatric Subspecialty Advanced Practice Provider Fellowship Training Programs to Optimize Advanced Practice Utilization in Pediatric Specialty Care and Facilitate Interprofessional Integration. J Contin Educ Nurs 2022; 53:478-480. [DOI: 10.3928/00220124-20221006-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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13
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Mayer J, Selim MA, Mahaffey JJ, Martin A, Hong JC. Assessment of Patient Knowledge of the Role of Advanced Practice Providers in Transplantation Surgical Care: A Single-Center Prospective Study. Transplant Proc 2022; 54:2616-2620. [DOI: 10.1016/j.transproceed.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
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Patel S, Kumar M, Beavers CJ, Karamat S, Alenezi F. Polypharmacy and Cardiovascular Diseases: Consideration for Older Adults and Women. Curr Atheroscler Rep 2022; 24:813-820. [PMID: 35861896 DOI: 10.1007/s11883-022-01055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The intent of this review is to provide an update in polypharmacy in older adults and women with a focus on common determinants and strategies to mitigate polypharmacy. RECENT FINDINGS Polypharmacy is becoming a critical focus in the management of cardiovascular diseases. It may emerge unintentionally while managing multimorbidity in older adults or in the vulnerable subgroup of patients, such as pregnant and lactating females. Clinicians should utilize several approaches such as deprescribing, sex-specific risk assessment, and encouraging healthy lifestyle to minimize inappropriate and unnecessary use of medications. A shared decision-making model along with coordination and collaboration among healthcare providers should be utilized in the selection and management of pharmacotherapies.
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Affiliation(s)
- Shreya Patel
- Department of Pharmacy Practice, Fairleigh Dickinson University - School of Pharmacy and Health Sciences, 230 Park Avenue, Florham Park, NJ, 07932, USA.
| | - Manish Kumar
- Department of Internal Medicine, Pat and Jim Calhoun Cardiology Center, UConn Health, CT, Farmington, USA
| | - Craig J Beavers
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Saad Karamat
- Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
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Team-Based Care in Patients with Chronic Limb-Threatening Ischemia. Curr Cardiol Rep 2022; 24:217-223. [PMID: 35129740 DOI: 10.1007/s11886-022-01643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Team-based care has been proposed as a tool to improve health care delivery, especially for the treatment of complex medical conditions. Chronic limb-threatening ischemia (CLTI) is a complex disease associated with significant morbidity and mortality which often involves the care of multiple specialty providers. Coordination of efforts across the multiple physician specialists, nurses, wound care specialists, and administrators is essential to providing high-quality and efficient care. The aim of this review is to discuss the multiple facets of care of the CLTI patient and to describe components important for a team-based care approach. RECENT FINDINGS Observational studies have reported improved outcomes when using a team-based care approach in the care of the patients with CLTI, including reduction in mean wound healing times, decreasing rate of amputations, and readmissions. Team-based care can streamline care of CLTI patients by raising awareness, facilitating early recognition, and providing prompt vascular assessment, revascularization, and surveillance. This approach has the potential to improve patient outcomes and reduce downstream health care costs.
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Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, Benjamin EJ, Branda M, Cavanaugh KL, Chen LY, Crossley GH, Delaney RK, Eckhardt LL, Grady KL, Hargraves IG, Hills MT, Kalscheur MM, Kramer DB, Kunneman M, Lampert R, Langford AT, Lewis KB, Lu Y, Mandrola JM, Martinez K, Matlock DD, McCarthy SR, Montori VM, Noseworthy PA, Orland KM, Ozanne E, Passman R, Pundi K, Roden DM, Saarel EV, Schmidt MM, Sears SF, Stacey D, Stafford RS, Steinberg BA, Wass SY, Wright JM. Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management. Circ Arrhythm Electrophysiol 2021; 14:e007958. [PMID: 34865518 PMCID: PMC8692382 DOI: 10.1161/circep.121.007958] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.
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Affiliation(s)
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT
- Salt Lake City Veterans Affairs Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, UT
| | | | | | | | | | | | - Megan Branda
- University of Colorado, Aurora, CO
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Marleen Kunneman
- Mayo Clinic, Rochester, MN
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Ying Lu
- Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | | - Dan M. Roden
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | | | - Sojin Youn Wass
- Cleveland Clinic, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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17
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Depressive symptoms in patients after primary and secondary prophylactic ICD implantation. Clin Res Cardiol 2021; 111:1210-1218. [PMID: 34779916 DOI: 10.1007/s00392-021-01940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Implantable cardioverter defibrillators (ICD) are successfully used to treat life-threatening arrhythmias and prevent sudden cardiac death. However, they are also known to have a major psychological impact leading to higher prevalence of depression and anxiety in a substantial proportion of patients. The aim of this study was to assess the prevalence of depressive symptoms in a large cohort of ICD carriers with a different clinical background and to compare prevalence and risk factors between patients with primary and secondary prophylactic indication for ICD implantation. METHODS 315 out of 622 patients (50.6%), who regularly attended ICD assessments at the University Hospital Zurich completed the Beck Depression Inventory (BDI I-II) to estimate current depressive symptoms. RESULTS Overall, depressive symptoms were common in ICD patients, with 20.3% of the patients showing clinically relevant depression (12.4% mild depressive symptoms, 6.0% moderate, 1.9% severe). Moderate to severe depressive symptoms seem to be more likely in patients with secondary prophylactic indication of the ICD as compared to a group of patients with primary prophylactic implantation. Patients that received more than 5 ICD shocks since implantation reveal more depressive symptoms than those with less events. Mean BDI Score in total (n = 315) was at 8.44 ± 7.56 without a statistically significant difference between the primary (M = 8.04 ± 7.10, n = 153) and secondary (M = 8.81 ± 7.98, n = 162) preventive group (p value = 0.362), even after adjustment for various clinical characteristics. ICD patients should therefore be well supported and advised concerning the psychological impact of their device and particular aspects of daily life concerns (e.g. physical activity), with a special focus on patients, who have received multiple shocks.
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Abstract
PURPOSE OF REVIEW Changing demands in healthcare, new leadership structures and physician preferences on work-life balance have made culture, teamwork and engagement vitally important for the long-term success of medical practices. With recent emphasis placed on culture, teamwork and engagement, leaders have had to acquire management skills that extend beyond the scope of being a successful clinician, educator and researcher. RECENT FINDINGS Over the last two decades, experts throughout the business and medical fields have worked to define culture. Furthermore, these authors have shown that success in businesses is often rooted in a strong organizational culture. Large surveys have confirmed that physicians value culture. They may join or leave a practice based on the culture. Furthermore, creating, defining and preserving culture requires leaders to be exemplary citizens and to inspire colleagues to be engaged. SUMMARY Practices and businesses that have been shown to have a strong culture with engaged employees form stronger teams which ultimately confers a competitive advantage. In the current era, culture fit should be considered during any hire. An organization's unique culture actively needs to be taught and cultivated by leaders. Employees will become more engaged and adopt a practice's culture with education and by following the example of others.
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Affiliation(s)
- Cyrus Samai
- Emory University School of Medicine, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
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19
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Winchester DE, Osborne A, Peacock WF, Bhatt DL, Dehmer GJ, Diercks D, Masoudi FA, McCord J, Kontos M, Levy PD. Closing Gaps in Essential Chest Pain Care Through Accreditation. J Am Coll Cardiol 2020; 75:2478-2482. [PMID: 32408982 DOI: 10.1016/j.jacc.2020.03.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- David E Winchester
- Malcom Randall Veterans Affairs Medical Center, University of Florida College of Medicine, Gainesville, Florida.
| | - Anwar Osborne
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - W Frank Peacock
- Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gregory J Dehmer
- Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Deborah Diercks
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, Texas
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James McCord
- Heart and Vascular Institute and Department of Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Michael Kontos
- Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Phillip D Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, Michigan
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20
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Tunoa JA, Billups SJ, Lowe RN, Saseen JJ. Early impact of the 2018 AHA/ACC/multisociety cholesterol guideline on lipid monitoring after statin initiation. J Clin Lipidol 2020; 14:784-790. [PMID: 32978094 DOI: 10.1016/j.jacl.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/26/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The 2018 AHA/ACC/multisociety cholesterol guideline emphasizes the need for lipid monitoring more strongly than the previous 2013 guideline to ensure patients reach recommended percent low-density lipoprotein cholesterol reductions. Real-world compliance to monitoring recommendations is currently unknown. OBJECTIVES This study examined the proportion of patients with a lipid panel measured within 3 months of statin initiation. METHODS This retrospective cohort study evaluated University of Colorado Health primary care patients aged 18 to 89 years with a new statin prescription identified via the Epic Clarity database. Patients initiated on a statin during January 1, 2018 to June 30, 2018 and January 1, 2019 to June 30, 2019 were included in the pre-2018 guideline cohort and the post-2018 guideline cohort, respectively. Patients with active liver disease, pregnancy, or missing demographic data were excluded. RESULTS A total of 13,726 patients were included, 7476 in the preguideline cohort and 6250 in the postguideline cohort. A total of 13.9% of patients in the preguideline cohort had a lipid panel completed within 3 months of statin initiation compared with 16.2% in the postguideline cohort (adjusted P < .001). In the postguideline cohort, 56% (n = 857) of patients with lipid monitoring warranted a therapeutic intensification as recommended by the 2018 guideline; however, only 5% had their lipid-lowering regimen changed. CONCLUSION In a large integrated health system, lipid monitoring increased among patients newly started on statin therapy soon after release of the 2018 guideline but remains low. Clinical interventions are needed to improve lipid monitoring to optimize low-density lipoprotein cholesterol-lowering therapy and ensure that guideline-recommended goals are achieved.
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Affiliation(s)
- Jennifer A Tunoa
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA
| | - Sarah J Billups
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA
| | - Rachel N Lowe
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA
| | - Joseph J Saseen
- University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA; University of Colorado Anschutz Medical Campus, Skaggs School of Medicine, Department of Family Medicine, Aurora, CO, USA.
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21
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Rodgers GP, Linderbaum JA, Pearson DD, Fernandes SM, Housholder-Hughes SD, Mendes LA, Berg NC, Day J, Drajpuch D, Erb B, Farquhar-Snow M, Johnson H, Keegan P, Kindler C, Larsen R, Le VT, Nickolaus MJ, Phillips CM, Ross L, Webb SR, Zado ES. 2020 ACC Clinical Competencies for Nurse Practitioners and Physician Assistants in Adult Cardiovascular Medicine: A Report of the ACC Competency Management Committee. J Am Coll Cardiol 2020; 75:2483-2517. [PMID: 32204958 DOI: 10.1016/j.jacc.2020.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Aeyels D, Bruyneel L, Seys D, Sinnaeve PR, Sermeus W, Panella M, Vanhaecht K. Better hospital context increases success of care pathway implementation on achieving greater teamwork: a multicenter study on STEMI care. Int J Qual Health Care 2020; 31:442-448. [PMID: 30256962 DOI: 10.1093/intqhc/mzy197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate whether hospital context influences the effect of care pathway implementation on teamwork processes and output in STEMI care. DESIGN A multicenter pre-post intervention study. SETTING Eleven acute hospitals. PARTICIPANTS Cardiologists-in-chief, nurse managers, quality staff, quality managers and program managers reported on hospital context. Teamwork was rated by professional groups (medical doctors, nurses, allied health professionals, other) in the following departments: emergency room, catheterization lab, coronary care unit, cardiology ward and rehabilitation. INTERVENTION Care pathway covering in-hospital care from emergency services to rehabilitation. MAIN OUTCOME MEASURES Hospital context was measured by the five dimensions of the Model for Understanding Success in Quality: microsystem, quality improvement team, quality improvement support, high-level organization, external environment. Teamwork process measures reflected teamwork between professional groups within departments and teamwork between departments. Teamwork output was measured through the level of organized care. Two-level regression analysis accounted for clustering of respondents within hospitals and assessed the influence of hospital context on the impact of care pathway implementation on teamwork. RESULTS Care pathway implementation significantly improved teamwork processes both between professional groups (P < 0.001) and between departments (P < 0.001). Teamwork output also improved (P < 0.001). The effect of care pathway implementation on teamwork was more pronounced when the quality improvement team and quality improvement support and capacity were more positively reported on. CONCLUSIONS Hospitals can leverage the effect of quality improvement interventions such as care pathways by evaluating and improving aspects of hospital context.
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Affiliation(s)
- Daan Aeyels
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | | | - Walter Sermeus
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium
| | - Massimiliano Panella
- Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Vercelli, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, University of Leuven, Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
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23
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Derington CG, King JB, Bryant KB, McGee BT, Moran AE, Weintraub WS, Bellows BK, Bress AP. Cost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care. Curr Hypertens Rep 2019; 21:91. [PMID: 31701259 DOI: 10.1007/s11906-019-0996-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Review the effectiveness, cost-effectiveness, and implementation challenges of intensive blood pressure (BP) control and team-based care initiatives. RECENT FINDINGS Intensive BP control is an effective and cost-effective intervention; yet, implementation in routine clinical practice is challenging. Several models of team-based care for hypertension management have been shown to be more effective than usual care to control BP. Additional research is needed to determine the cost-effectiveness of team-based care models relative to one another and as they relate to implementing intensive BP goals. As a focus of healthcare shifts to value (i.e., cost, effectiveness, and patient preferences), formal cost-effectiveness analyses will inform which team-based initiatives hold the highest value in different healthcare settings with different populations and needs. Several challenges, including clinical inertia, financial investment, and billing restrictions for pharmacist-delivered services, will need to be addressed in order to improve public health through intensive BP control and team-based care.
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Affiliation(s)
- Catherine G Derington
- Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jordan B King
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, 84112, USA
| | - Kelsey B Bryant
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Blake T McGee
- Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, GA, USA
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Brandon K Bellows
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Adam P Bress
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA.
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24
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Reed BN, Klutts AM, Mattingly TJ. A Systematic Review of Leadership Definitions, Competencies, and Assessment Methods in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7520. [PMID: 31871362 PMCID: PMC6920635 DOI: 10.5688/ajpe7520] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/19/2019] [Indexed: 05/22/2023]
Abstract
Objective. To characterize leadership definitions, competencies, and assessment methods used in pharmacy education, based on a systematic review of the literature. Findings. After undergoing title, abstract, and full-text review, 44 (10%) of 441 articles identified in the initial search were included in this report. Leadership or an aspect of leadership was defined in 37 (84%) articles, and specific leadership competencies were listed or described in 40 (91%) articles. The most common definitions of leadership involved motivating others toward the achievement of a specific goal and leading organizational change. Definitions of leadership in some articles required that individuals hold a formal leadership position whereas others did not. Only two leadership competencies were related to specific areas of knowledge. Most of the competencies identified were interpersonal and self-management skills. In terms of assessment, only one (2.3%) article assessed leadership effectiveness, and none assessed leadership development. Of the remaining 24 (55%) articles that included some type of assessment, most involved behavioral-based tools assessing individual attributes conceptually related to leadership (eg, strengths, emotional intelligence), or self-assessments regarding whether learning objectives in a leadership course had been met. Summary. Definitions for leadership in pharmacy varied considerably, as did leadership competencies. Most conceptualizations of leadership resembled a combination of established approaches rather than being grounded in a specific theory. If leadership development is to remain a focus within accreditation standards for Doctor of Pharmacy education, a consistent framework for operationalizing it is needed.
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Affiliation(s)
- Brent N. Reed
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | | | - T. Joseph Mattingly
- University of Maryland School of Pharmacy, Baltimore, Maryland
- Editorial Board Member, American Journal of Pharmaceutical Education, Arlington, Virginia
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25
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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26
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e426-e483. [PMID: 30354655 DOI: 10.1161/cir.0000000000000597] [Citation(s) in RCA: 356] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74:e177-e232. [PMID: 30894318 PMCID: PMC7685565 DOI: 10.1016/j.jacc.2019.03.010] [Citation(s) in RCA: 882] [Impact Index Per Article: 176.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140:e596-e646. [PMID: 30879355 PMCID: PMC7734661 DOI: 10.1161/cir.0000000000000678] [Citation(s) in RCA: 1275] [Impact Index Per Article: 255.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Empowering Nurses to Lead Efforts to Reduce Cardiovascular Disease and Stroke Risk. J Cardiovasc Nurs 2019; 34:357-360. [DOI: 10.1097/jcn.0000000000000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ng TMH, DiDomenico RJ, Ripley TL, Benge CD, Buckley LF, Campbell KB, Hale GM, Macaulay TE, Nappi JM, Pickworth KK, Short MR. An opinion paper of the Cardiology Practice and Research Network of the American College of Clinical Pharmacy: Recommendations for training of cardiovascular pharmacy specialists in postgraduate year 2 residency programs. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tien M. H. Ng
- School of Pharmacy; University of Southern California; Los Angeles California
| | | | - Toni L. Ripley
- College of Pharmacy; University of Oklahoma; Oklahoma City Oklahoma
| | | | | | | | - Genevieve M. Hale
- College of Pharmacy; Nova Southeastern University; Palm Beach Gardens Florida
| | | | - Jean M. Nappi
- College of Pharmacy; Medical University of South Carolina; Charleston South Carolina
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Sardana M, Tang Y, Magnani JW, Ockene IS, Allison JJ, Arnold SV, Jones PG, Maddox TM, Virani SS, McManus DD. Provider-Level Variation in Smoking Cessation Assistance Provided in the Cardiology Clinics: Insights From the NCDR PINNACLE Registry. J Am Heart Assoc 2019; 8:e011412. [PMID: 31248329 PMCID: PMC6662347 DOI: 10.1161/jaha.118.011307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/30/2019] [Indexed: 01/14/2023]
Abstract
Background Studies show suboptimal provision of smoking cessation assistance (counseling or pharmacotherapy) for current smokers attempting to quit. We aimed to identify smoking cessation assistance patterns in US cardiology practices. Methods and Results Among 328 749 current smokers seen between January 1, 2013, and March 31, 2016, in 348 NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence)-affiliated cardiology practices, we measured the rates of cessation assistance. We used multivariable hierarchical logistic regression models to determine provider-, practice-, and patient-level predictors of cessation assistance. We measured provider variation in cessation assistance using median rate ratio (the likelihood that the same patient would receive the same assistance at by any given provider; >1.2 suggests significant variation). Smoking cessation assistance was documented in only 34% of encounters. Despite adjustment of provider, practice, and patient characteristics, there was large provider-level variation in cessation assistance (median rate ratio, 6 [95% CI , 5.76-6.32]). Practice location in the South region (odds ratio [OR], 0.48 [0.37-0.63] versus West region) and rural or suburban location (OR, 0.92 [0.88-0.95] for rural; OR, 0.94 [0.91-0.97] for suburban versus urban) were associated with lower rates of cessation assistance. Similarly, older age (OR, 0.88 [0.88-0.89] per 10-year increase), diabetes mellitus (OR, 0.84 [0.82-0.87]), and atrial fibrillation (OR, 0.93 [0.91-0.96]) were associated with lower odds of receiving cessation assistance. Conclusions In a large contemporary US registry, only 1 in 3 smokers presenting for a cardiology visit received smoking cessation assistance. Our findings suggest the presence of a large deficit and largely idiosyncratic provider-level variation in the provision of smoking cessation assistance.
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Affiliation(s)
| | | | | | - Ira S. Ockene
- University of Massachusetts Medical SchoolWorcesterMA
| | | | | | | | | | - Salim S. Virani
- Michael E. DeBakey Veterans Affairs Medical CenterSection of Cardiovascular ResearchDepartment of MedicineBaylor College of MedicineHoustonTX
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 540] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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Thompson DR, Astin F. Education for advanced nursing practice worldwide – Is it fit for purpose? Heart Lung 2019; 48:176-178. [DOI: 10.1016/j.hrtlng.2019.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Butala NM, Hidrue MK, Swersey AJ, Singh JP, Weilburg JB, Ferris TG, Armstrong KA, Wasfy JH. Measuring individual physician clinical productivity in an era of consolidated group practices. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 7:S2213-0764(18)30051-4. [PMID: 30744992 DOI: 10.1016/j.hjdsi.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND As physician groups consolidate and value-based payment replaces traditional fee-for-service systems, physician practices have greater need to accurately measure individual physician clinical productivity within team-based systems. We compared methodologies to measure individual physician outpatient clinical productivity after adjustment for shared practice resources. METHODS For cardiologists at our hospital between January 2015 and June 2016, we assessed productivity by examining completed patient visits per clinical session per week. Using mixed-effects models, we sequentially accounted for shared practice resources and underlying baseline characteristics. We compared mixed-effects and Generalized Estimating Equations (GEE) models using K-fold cross validation, and compared mixed-effect, GEE, and Data Envelopment Analysis (DEA) models based on ranking of physicians by productivity. RESULTS A mixed-effects model adjusting for shared practice resources reduced variation in productivity among providers by 63% compared to an unadjusted model. Mixed-effects productivity rankings correlated strongly with GEE rankings (Spearman 0.99), but outperformed GEE on K-fold cross validation (root mean squared error 2.66 vs 3.02; mean absolute error 1.89 vs 2.20, respectively). Mixed-effects model rankings had moderate correlation with DEA model rankings (Spearman 0.692), though this improved upon exclusion of outliers (Spearman 0.755). CONCLUSIONS Mixed-effects modeling accounts for significant variation in productivity secondary to shared practice resources, outperforms GEE in predictive power, and is less vulnerable to outliers than DEA. IMPLICATIONS With mixed-effects regression analysis using otherwise easily accessible administrative data, practices can evaluate physician clinical productivity more fairly and make more informed management decisions on physician compensation and resource allocation.
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Affiliation(s)
- Neel M Butala
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Michael K Hidrue
- Massachusetts General Physicians Organization, Boston, MA, United States
| | | | - Jagmeet P Singh
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey B Weilburg
- Massachusetts General Physicians Organization, Boston, MA, United States
| | - Timothy G Ferris
- Massachusetts General Physicians Organization, Boston, MA, United States; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Katrina A Armstrong
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Massachusetts General Physicians Organization, Boston, MA, United States.
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Abstract
OBJECTIVE This study investigated how professional development benefits offered by employers directly correlate to self-perceptions of leadership potential, committee involvement, and career satisfaction among physician assistants (PAs). METHODS A retrospective analysis of the 2015 AAPA National Survey and 2016 AAPA Salary Survey explored the associations between the aforementioned variables. Bivariate correlations were used to evaluate the associations between variables. RESULTS Self-perceived leadership attributes were found to be mildly and positively correlated with the number of committees a PA was involved in (P < .001; correlation coefficient (CC) = 0.245). Of the investigated factors, only leadership potential was significantly correlated with career satisfaction (P ≤ .001; CC = 0.059). The proportion of professional development fees, memberships, and expenses covered by employers had no bearing on career satisfaction (P = .438). CONCLUSIONS Irrespective of the benefits received, PAs were satisfied with their careers. Intrinsic rewards may have a greater positive association with career satisfaction than extrinsic benefits alone.
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Job Satisfaction Among Physician Assistants Practicing Cardiovascular Medicine in the United States. Health Care Manag (Frederick) 2019; 38:11-23. [DOI: 10.1097/hcm.0000000000000244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Norful AA, Ye S, Van der-Biezen M, Poghosyan L. Nurse Practitioner-Physician Comanagement of Patients in Primary Care. Policy Polit Nurs Pract 2018; 19:82-90. [PMID: 30517047 DOI: 10.1177/1527154418815024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider comanagement of the same patient has emerged in practice. Provider comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician-physician comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)-physician comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP-physician comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP-physician comanagement. Physicians and NPs are optimistic about comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP-physician comanagement should be supported in clinical practice.
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Affiliation(s)
- Allison A Norful
- Columbia University School of Nursing, New York, NY, USA.,Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.,Columbia Doctors, New York, NY, USA
| | - Mieke Van der-Biezen
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Scientific Center for Quality of Health care, IQ Health care, Radboud University Medical Center, Nijmegen, the Netherlands
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Forcino RC, Yen RW, Aboumrad M, Barr PJ, Schubbe D, Elwyn G, Durand MA. US-based cross-sectional survey of clinicians' knowledge and attitudes about shared decision-making across healthcare professions and specialties. BMJ Open 2018; 8:e022730. [PMID: 30341128 PMCID: PMC6196864 DOI: 10.1136/bmjopen-2018-022730] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE In this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties. SETTING We administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017. PARTICIPANTS 272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US. RESULTS We found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making. CONCLUSIONS Recent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.
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Affiliation(s)
- Rachel C Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Renata West Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Maya Aboumrad
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. ACTA ACUST UNITED AC 2018; 12:579.e1-579.e73. [DOI: 10.1016/j.jash.2018.06.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Martsolf GR, Barnes H, Richards MR, Ray KN, Brom HM, McHugh MD. Employment of Advanced Practice Clinicians in Physician Practices. JAMA Intern Med 2018; 178:988-990. [PMID: 29710094 PMCID: PMC6126674 DOI: 10.1001/jamainternmed.2018.1515] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines trends in advanced practice clinician employment across different physician practices in the United States.
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Affiliation(s)
- Grant R Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania.,RAND Corporation, Pittsburgh, Pennsylvania
| | - Hilary Barnes
- School of Nursing, University of Delaware, Newark, Delaware
| | - Michael R Richards
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristin N Ray
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather M Brom
- Center for Healthcare Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew D McHugh
- Center for Healthcare Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Fentanes E, Vande Hei AG, Holuby RS, Suarez N, Slim Y, Slim JN, Slim AM, Thomas D. Treatment in a preventive cardiology clinic utilizing advanced practice providers effectively closes atherosclerotic cardiovascular disease risk-management gaps among a primary-prevention population compared with a propensity-matched primary-care cohort: A team-based care model and its impact on lipid and blood pressure management. Clin Cardiol 2018; 41:817-824. [PMID: 29667200 PMCID: PMC6489740 DOI: 10.1002/clc.22963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/01/2022] Open
Abstract
Background Advanced practice providers (APPs) can fill care gaps created by physician shortages and improve adherence/compliance with preventive ASCVD interventions. Hypothesis APPs utilizing guideline‐based algorithms will more frequently escalate ASCVD risk factor therapies. Methods We retrospectively reviewed data on 595 patients enrolled in a preventive cardiology clinic (PCC) utilizing APPs compared with a propensity‐matched cohort (PMC) of 595 patients enrolled in primary‐care clinics alone. PCC patients were risk‐stratified using Framingham Risk Score (FRS) and coronary artery calcium scoring (CACS). Results Baseline demographics were balanced between the groups. CACS was more commonly obtained in PCC patients (P < 0.001), resulting in reclassification of 30.6% patients to a higher risk category, including statin therapy in 26.6% of low‐FRS PCC patients with CACS ≥75th MESA percentile. Aspirin initiation was higher for high and intermediate FRS patients in the PCC (P < 0.001). Post‐intervention mean LDL‐C, non–HDL‐C, and triglycerides (all P < 0.05) were lower in the PCC group. Compliance with appropriate lipid treatment was higher in intermediate to high FRS patients (P = 0.004) in the PCC group. Aggressive LDL‐C and non–HDL‐C treatment goals (<70 mg/dL, P = 0.005 and < 130 mg/dL, P < 0.001, respectively), were more commonly achieved in high‐FRS PCC patients. Median post‐intervention SBP was lower among intermediate and low FRS patients (P = 0.001 and P < 0.001, respectively). Cumulatively, this resulted in a reduction in median post‐intervention PCC FRS across all initial FRS risk categories (P < 0.001 for all). Conclusions APPs within a PCC effectively risk‐stratify and aggressively manage ASCVD risk factors, resulting in a reduction in post‐intervention FRS.
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Affiliation(s)
- Emilio Fentanes
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
| | - Anthony G Vande Hei
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
| | - R Scott Holuby
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
| | - Norma Suarez
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
| | - Yousif Slim
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
| | - Jennifer N Slim
- Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas
| | - Ahmad M Slim
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
| | - Dustin Thomas
- Cardiology Department, San Antonio Military Medical Center, San Antonio, Texas
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Norful AA, de Jacq K, Carlino R, Poghosyan L. Nurse Practitioner-Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain. Ann Fam Med 2018; 16:250-256. [PMID: 29760030 PMCID: PMC5951255 DOI: 10.1370/afm.2230] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/01/2017] [Accepted: 11/30/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. METHODS We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. RESULTS Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. CONCLUSIONS Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting.
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Affiliation(s)
- Allison A Norful
- Columbia University School of Nursing, New York, New York .,Columbia University Medical Center Irving Institute for Clinical and Translational Research, New York, New York
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Pittman P, Leach B, Everett C, Han X, McElroy D. NP and PA Privileging in Acute Care Settings: Do Scope of Practice Laws Matter? Med Care Res Rev 2018; 77:112-120. [DOI: 10.1177/1077558718760333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As hospitals’ interest in nurse practitioners (NPs) and physician assistants (PAs) grows, their leadership is eager to know how their medical staffing privileging policies for these professionals compare to peer hospitals. This study assesses the extent of variation of these policies in four clinical areas and examines whether the differences are associated with state scope of practice laws for NPs and PAs. We also examine the relationship of NP and PA privileging policies to each other. Our analysis finds no evidence that hospital privileging is associated with state scope of practice, and indeed within-state variation is more significant than cross-state variation. We also find a strong correlation between NP and PA privileging in all four clinical areas. These results suggest the need for additional research to understand the institutional-level variables and human dynamics at the level of medical staffing committees that may explain the dramatic variation in privileging policies and, ultimately, the effects of different privileging levels on costs and quality.
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Affiliation(s)
| | | | | | - Xinxin Han
- George Washington University, Washington, DC, USA
| | - Debra McElroy
- American Case Management Association, Little Rock, AR, USA
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Anderson JB, Chowdhury D, Connor JA, Daniels CJ, Fleishman CE, Gaies M, Jacobs J, Kugler J, Madsen N, Beekman RH, Lihn S, Stewart-Huey K, Vincent R, Campbell R. Optimizing patient care and outcomes through the congenital heart center of the 21st century. CONGENIT HEART DIS 2018; 13:167-180. [DOI: 10.1111/chd.12575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Craig E. Fleishman
- The Heart Center at Arnold Palmer Hospital for Children; Orlando Florida USA
| | - Michael Gaies
- University of Michigan Congenital Heart Center; Ann Arbor Michigan USA
| | - Jeffrey Jacobs
- Johns Hopkins All Children's Hospital and Florida Hospital for Children; St. Petersburg Florida USA
- Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - John Kugler
- Children's Hospital & Medical Center; Omaha Nebraska USA
| | - Nicolas Madsen
- Heart Institute, Cincinnati Children's Hospital; Cincinnati Ohio USA
| | - Robert H. Beekman
- University of Michigan Congenital Heart Center; Ann Arbor Michigan USA
| | - Stacey Lihn
- Sisters-by-Heart, El Segundo; California USA
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Auerbach SR, Everitt MD, Butts RJ, Rosenthal DN, Law YM. The Pediatric Heart Failure Workforce: An International, Multicenter Survey. Pediatr Cardiol 2018; 39:307-314. [PMID: 29147800 DOI: 10.1007/s00246-017-1756-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 10/24/2017] [Indexed: 11/25/2022]
Abstract
Our objective was to understand the scope of pediatric heart failure (HF) and the current staffing environment of HF programs. An online survey was distributed to members of the Pediatric Heart Transplant Study and the Pediatric Council of the International Society for Heart and Lung Transplantation. All participants received the primary 23-question survey. Additionally, HF program directors received a 32-question supplemental survey. Of 235 invitations sent, there were 69 (29%) primary surveys and 34 program director surveys completed (24 U.S. programs, 9 outside non-U.S., and one non-specified location). A formal HF program was reported by 88% of directors. There were 150 [IQR 50-200] outpatients/institution and 40% [25-50] of patients had congenital heart disease. Inpatient HF census was 3 [2-4] patients. Most programs (70%) used a consulting service model to provide HF specialty care, while only 10 (30%) utilized an inpatient HF service. Inpatient HF service programs had a higher daily inpatient census versus consult service model programs (4 [3-7] vs. 2 [1-4], respectively; p = 0.022) and had a higher number of full-time equivalents dedicated to HF (5.5 [2-7] vs. 2.5 [1-4], respectively; p = 0.024). Only 47% of programs report a general fellowship rotation devoted to HF. Advanced practice providers (APP) were utilized in 15 programs, nurse coordinators in 2, and both in 3. Most HF programs are formalized, utilize APP, and have inadequate HF staffing to utilize a separate inpatient HF service. Exposure of general pediatric cardiology fellows to HF care is variable between institutions.
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Affiliation(s)
- Scott R Auerbach
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado Heart Institute, Aurora, CO, USA.
| | - Melanie D Everitt
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado Heart Institute, Aurora, CO, USA
| | - Ryan J Butts
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - David N Rosenthal
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Yuk M Law
- Division of Cardiology, Department of Pediatrics, Children's Hospital & Regional Medical Center, University of Washington, Seattle, WA, USA
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Mathews R, Wang W, Kaltenbach LA, Thomas L, Shah RU, Ali M, Peterson ED, Wang TY. Hospital Variation in Adherence Rates to Secondary Prevention Medications and the Implications on Quality. Circulation 2018; 137:2128-2138. [PMID: 29386204 DOI: 10.1161/circulationaha.117.029160] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 01/04/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medication adherence is important to improve the long-term outcomes after acute myocardial infarction (MI). We hypothesized that there is significant variation among US hospitals in terms of medication adherence after MI, and that patients treated at hospitals with higher medication adherence after MI will have better long-term cardiovascular outcomes. METHODS We identified 19 704 Medicare patients discharged after acute MI from 347 US hospitals participating in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines) from January 2, 2007, to October 1, 2010. Using linked Medicare Part D prescription filling data, medication adherence was defined as proportion of days covered >80% within 90 days after discharge. Cox proportional hazards modeling was used to compare 2-year major adverse cardiovascular events among hospitals with high, moderate, and low 90-day medication adherence. RESULTS By 90 days after MI, overall rates of adherence to medications prescribed at discharge were 68% for β-blockers, 63% for statins, 64% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 72% for thienopyridines. Adherence to these medications up to 90 days varied significantly among hospitals: β-blockers (proportion of days covered >80%; 59% to 75%), statins (55% to 69%), thienopyridines (64% to 77%), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (57% to 69%). Compared with hospitals in the lowest quartile of 90-day composite medication adherence, hospitals with the highest adherence had lower unadjusted and adjusted 2-year major adverse cardiovascular event risk (27.5% versus 35.3%; adjusted hazard ratio, 0.88; 95% confidence interval, 0.80-0.96). High-adherence hospitals also had lower adjusted rates of death or readmission (hazard ratio, 0.90; 95% confidence interval, 0.85-0.96), whereas there was no difference in mortality after adjustment. CONCLUSIONS Use of secondary prevention medications after discharge varies significantly among US hospitals and is inversely associated with 2-year outcomes. Hospitals may improve medication adherence after discharge and patient outcomes through better coordination of care between inpatient and outpatient settings.
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Affiliation(s)
- Robin Mathews
- Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.)
| | - William Wang
- Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.)
| | - Lisa A Kaltenbach
- Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.)
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.)
| | - Rashmee U Shah
- University of Utah School of Medicine, Salt Lake City (R.U.S.)
| | - Murtuza Ali
- Louisiana State University School of Medicine, New Orleans (M.A.)
| | - Eric D Peterson
- Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.)
| | - Tracy Y Wang
- Duke Clinical Research Institute, Durham, NC (R.M., W.W., L.A.K., L.T., E.D.P., T.Y.W.)
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Dixon DL, Sisson EM, Parod ED, Van Tassell BW, Nadpara PA, Carl D, W. Dow A. Pharmacist-physician collaborative care model and time to goal blood pressure in the uninsured population. J Clin Hypertens (Greenwich) 2018; 20:88-95. [PMID: 29237095 PMCID: PMC8031164 DOI: 10.1111/jch.13150] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/31/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
Pharmacist-physician collaborative practice models (PPCPMs) improve blood pressure (BP) control, but their effect on time to goal BP is unknown. This retrospective cohort study evaluated the impact of a PPCPM on time to goal BP compared with usual care using data from existing medical records in uninsured patients with hypertension. The primary outcome was time from the initial visit to the first follow-up visit with a BP <140/90 mm Hg. The study included 377 patients (259 = PPCPM; 118 = usual care). Median time to BP goal was 36 days vs 259 days in the PPCPM and usual care cohorts, respectively (P < .001). At 12 months, BP control was 81% and 44% in the PPCPM and usual care cohorts, respectively (P < .001) and therapeutic inertia was lower in the PPCPM cohort (27.6%) compared with usual care (43.7%) (P < .0001). Collaborative models involving pharmacists should be considered to improve BP control in high-risk populations.
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Affiliation(s)
- Dave L. Dixon
- Center for Pharmacy Practice InnovationVirginia Commonwealth University School of PharmacyRichmondVAUSA
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Evan M. Sisson
- Center for Pharmacy Practice InnovationVirginia Commonwealth University School of PharmacyRichmondVAUSA
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Eric D. Parod
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Benjamin W. Van Tassell
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Pramit A. Nadpara
- Department of Pharmacotherapy & Outcomes ScienceVirginia Commonwealth University School of PharmacyRichmondVAUSA
| | - Daniel Carl
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Alan W. Dow
- Department of Internal MedicineVirginia Commonwealth University School of MedicineRichmondVAUSA
- Center for Interprofessional Education and Collaborative CareVirginia Commonwealth UniversityRichmondVAUSA
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