Organizing Your Practice for Screening and Secondary Prevention Among Adults

[Arterial hypertension at the time of diagnosis of type 2 diabetes in adults]

AIM OF STUDY

Our aim was to determine the prevalence of arterial hypertension and evaluate its association with vascular chronic complications in newly diagnosed type 2 diabetes patients, in an observational, prospective study.

MATERIAL AND METHODS

We have recruited 327 newly diagnosed type 2 diabetics aged from 40 to 70 years, in general practice units. Arterial blood pressure has been measured according to WHO guidelines. All data on clinical examination, diabetes's chronic complications were collected during 6 months and statistically analyzed with Epi-Info 6.04 database program.

RESULTS

Among the patients, 66.7% had arterial hypertension at diagnosis of diabetes, 28% were known as hypertensive. They were 54.3±8.4years old and have metabolic syndrome in 88.4%. Men have more frequently a higher cardiovascular risk, higher glycaemia and albuminuria; women were more likely to have a metabolic syndrome and a higher BMI. Blood pressure increases with cardiovascular risk and metabolic syndrome components. Microangiopathy is present in 65.7%, atherosclerosis in 59.4 and 71.2% of hypertensive patients who have atherosclerosis have also microvascular complications.

CONCLUSION

The prevalence of arterial hypertension in newly diagnosed type 2 diabetes is high. This association is linked with an alarming level of vascular morbidity. Early detection and treatment of these two diseases need a better implication and motivation of patients and health care providers. Clinicaltrials.gov ID: NCT02002091.

State Law and Standing Orders for Immunization Services

INTRODUCTION

This study determined whether state laws permit the implementation of standing orders programs (SOPs) for immunization practice. SOPs are an effective strategy to increase uptake of vaccines. Successful SOPs require a legal foundation authorizing delegation of immunization services performed by a wide range of providers, administered to broad patient populations, in several settings. Without legal permission to administer vaccines, non-physician health professionals (NPHPs) are unable to provide preventive services.

METHODS

From 2012 through 2013, researchers analyzed the legal environment in 50 states and the District of Columbia to determine whether NPHPs are authorized to (1) assess patient immunization status; (2) prescribe vaccines; and (3) administer vaccines under their own practice license or delegated authority. Laws governing the following NPHPs were included: (1) medical assistants; (2) midwives; (3) nurses in advanced practice; (4) registered, practical, and vocational nurses; (5) physician assistants; and (6) pharmacists. Additionally, the review determined which vaccines may be administered, permissible patient populations, and allowable practice settings for each category of NPHP.

RESULTS

The laws are highly variable, and no state authorizes all NPHPs to conduct all elements of immunization practice for all patients. The laws frequently indicate where NPHPs may or may not administer vaccines and outline permissible vaccines, eligible patients, and required level of supervision.

CONCLUSIONS

The variation in the laws could potentially present a challenge to successful implementation of public health goals to improve immunization rates. Expanded authorization of SOPs in all states could increase health practitioners' ability to deliver recommended vaccines.