The Legislative and Policy Environment for Adolescent Health in Latin America and the Caribbean medications venlafaxine er 75mg chloroquine 250mg. Women of the World: Laws and Policies Affecting Their Reproductive Lives symptoms breast cancer cheap chloroquine 250 mg with mastercard, Latin America and the Caribbean medicine jar paul mccartney discount 250mg chloroquine overnight delivery. Avances y Retos de la Salud Reproductiva en Mexico: Discurso treatment interventions chloroquine 250mg with mastercard, Financiamiento y Praxis. Childhood and Youth in Germany and the Netherlands: Transition and Coping of Adolescents. Cross-Cultural Differences in Adolescent Sexual Behavior and Attitudes to Contraception. Halfway There: A Prescription for Continued Progress in Preventing Teen Pregnancy. Resident Population Estimates of the United States by Age and Sex: April 1, 1990 to July 1, 1999 with Short-Term Projection to November 1, 2000. Creating Access to Care for Children and Youth: School-Based Health Center Census 1998-1999. The Commonwealth Fund Survey of the Health of Adolescent Girls: Facts on Access to Health Care. Measuring Up: Assessing State Policies to Promote Adolescent Sexual and Reproductive Health, An Assessment of Policies in All 50 States 1(3). Melissa Draper Bill Green Kaval Gulhati Jonathan Lash Yolonda Richardson Barbara Roberts Allan Rosenfield Fred T. We focused our reviews on young people, ages 10-24, in lower- and middle-income countries. Our reviews focus on both the content and quality of the interventions as well as the evaluations. This report summarizes the overall findings, by outcome area, providing two to three case studies of effective interventions for each outcome. Results: Table 1 below shows a summary of our search results and ratings for each outcome. The majority of the studies (n=37) found a positive impact of the intervention on some component of early marriage-practices, knowledge or attitudes. A final group of interventions had no results reported on early marriage or had no data from which to draw conclusions (n=9). Among 37 studies with positive results, fewer than half (n=16) had high quality interventions and evaluations. Early Pregnancy: We abstracted 97 out of over 27,000 titles screened that related to interventions designed to prevent early pregnancy (56 grey literature articles and 42 published peer-reviewed articles). The majority of the studies (n=62) found a positive impact of the intervention on some component of early pregnancy-knowledge, attitudes or behavior. A substantial number of studies had mixed or contradictory results (n=23), and just a handful (n=9) had negative results. Among the studies 62 studies with positive results, few (n=14) had high quality interventions and evaluations. Number of children: We abstracted 11 articles out of over 1600 titles screened that related to interventions designed to prevent repeat pregnancies and births (5 grey literature and 6 published peer-reviewed articles). The majority of the studies (n=8) found a positive impact of the intervention on some component of preventing repeat pregnancies including uptake of contraception, and avoiding repeat pregnancies. Among the studies with positive results (n=8), only two had high quality interventions and evaluations. Of all the interventions, nearly the same number showed uniformly positive results (n=39) as negative or no results (n=38). Nearly the same number of studies had positive (n=38), as had negative results (n=39). Among the studies with positive results (n=38), only nine had high quality interventions and evaluations. The concluding chapter outlines our recommendations for the field as well as some specific recommendations related to each of the four outcomes. Each chapter contains a list of cited references, as well as a full bibliography all of the articles reviewed. Acknowledgements: We would like to thank those that contributed to the work in this report: Bruce Dick, Bob Blum and Jane Ferguson who composed our group of senior advisors. Angela Bayer, Akin Omisore, Jaya, Susan Lee-Rife, Terri-Ann Thompson, and Ushma Upadhyay who identified and abstracted the studies featured in this report. Virginia Bowen and Carie Muntifering Cox who were instrumental in the coordination and oversight of the work. In building the search, we combined a list of terms that describe young people with a list of terms that describe marriage or marriage-like arrangements. This initial search produced 3,652 hits about early marriage, which were stored using EndNote reference manager software. This title screening reduced the original list of 3,652 hits down to 51 articles that seemed relevant. We read each of the 51 abstracts and pulled all articles that appeared to pertain to early marriage interventions for further review. This narrowed the list from 51 hits to 10 published articles that were included for abstraction. A total of 13 documents synthesizing early marriage interventions were identified through the initial search process and reference tracing (snowballing) was employed to find as many referenced interventions as possible. Results We abstracted 59 articles that related to interventions designed to change early marriage or age at first marriage (49 grey literature articles and 10 published peer-reviewed articles). Intervention Characteristics the articles represented primarily rural interventions (n=37), although some were both rural and urban (n=16) and a minority of the interventions were urban only (n=6). The majority of interventions were community based (n=41), followed by school based (n=13), a mix of community and school based (n=4), and varied (multiple interventions reviewed n=1). In terms of how early marriage was operationalized, the definitions were not consistent across interventions. The majority of studies had no clear definition of early marriage (n=26), while seventeen used "before age 18" as the definition, with reference to legal age of marriage, a number gave different specific age ranges (e. The remaining interventions focused on being able to negotiate marriage age with parents (n=1) or age at first marriage (n=1). Interventions that scores in the low range (n=11) often had limited information about the intervention and the activities, had broad goals rather than specifically targeting early marriage, or had no comparison group (or an inappropriate comparison group). Many of interventions fell in the moderate quality group (n=19), based on receiving a score of 3. The limitations of these interventions were similar to the lower scoring interventions, but less severe. In addition, limitations also included concern about the impact of the interventions on the targeted groups. Interventions receiving a score of 4 (n=21) had significant positive aspects that outweighed the limitations. Among noted positive aspects were basing the intervention on a theory of change, being well-planned and organized, or targeting a population rather than selected individuals. Most of the evaluations were a pre/post design (n=34), three were post-only, and the remaining (n=22) were other designs. The qualitative evaluations often included multiple evaluation methodologies within a single intervention study including focus groups (n=16 ), in-depth interviews (n=12 ), semi-structured interviews (n=6), key informant interviews (n=4) desk review of documents (n=4), case studies (n=3), and others including photovoice and sketching (n=3). The lowest scoring evaluations (n=22) had few to no strengths, and serious flaws including no statistical analysis for quantitative studies, select samples (e. Thirteen of the evaluations scored in the moderate range (score=3), based on have some strengths but significant limitations.
Further research is required to validate existing subregional risk prediction charts for individual populations at national and local levels treatment jalapeno skin burn proven chloroquine 250mg, and to confirm that the use of risk stratification methods in low- and middle-income countries results in benefits for both patients and the health care system treatment 5th metatarsal fracture cheap 250 mg chloroquine with mastercard. These charts are intended to allow the introduction of the total risk stratification approach for management of cardiovascular disease medicine 7767 quality 250mg chloroquine, particularly where cohort data and resources are not readily available for development of population-specific charts medications knowledge best 250 mg chloroquine. The charts have been generated from the best available data, using a modelling approach (Annex 5), with age, sex, smoking, blood pressure, blood cholesterol, and presence of diabetes as clinical entry points for overall management of cardiovascular risk. Some studies have suggested that diabetic patients have a high cardiovascular risk, similar to that of patients with established cardiovascular disease, and so do not need to be risk-assessed. In addition, in people with diabetes, there is no gender difference in the risk of coronary heart disease and stroke (82). Therefore, separate charts have been developed for assessment of cardiovascular risk in patients with type 2 diabetes. In many low-resource settings, there are no facilities for cholesterol assay, although it is often feasible to check urine sugar as a surrogate measure for diabetes. Annex 4 therefore contains risk prediction charts that do not use cholesterol, but only age, sex, smoking, systolic blood pressure, and presence or absence of diabetes to predict cardiovascular risk. These risk factors are not included in the charts, which may therefore underestimate actual risk in people with these characteristics. While including these risk factors in risk stratification would improve risk prediction in most populations, the increased gain would not usually be large, and does not warrant waiting to develop and validate further risk stratification tools. Nevertheless, these (and other) risk factors may be important for risk prediction, and some of them may be causal factors that should be managed. The risk prediction charts and the accompanying recommendations can be used by health care professionals to match the intensity of risk factor management with the likelihood of cardiovascular disease events. The charts can also be used to explain to patients the likely impact of interventions on their individual risk of developing cardiovascular disease. The use of charts will help health care professionals to focus their limited time on those who stand to benefit the most. It should be noted that the risk predictions are based on epidemiological data from groups of people, rather than on clinical practice. However, these objections do not detract from their potential to bring much-needed coherence to the clinical dilemmas of how to apply evidence from randomized trials in clinical practice, and of who to treat with a growing range of highly effective but costly interventions. Clinical assessment of cardiovascular risk Clinical assessment should be conducted with four aims: to search for all cardiovascular risk factors and clinical conditions that may influence prognosis and treatment; to determine the presence of target organ damage (heart, kidneys and retina); to identify those at high risk and in need of urgent intervention; to identify those who need special investigations or referral (e. Physical examination A full physical examination is essential, and should include careful measurement of blood pressure, as described below. Measuring blood pressure Health care professionals need to be adequately trained to measure blood pressure. In addition, blood pressure measuring devices need to be validated, maintained and regularly calibrated to ensure that they are accurate (84). Two readings should be taken; if the average is 140/90 mmHg or more, an additional reading should be taken at the end of the consultation for confirmation. Blood pressure should be measured in both arms initially, and the arm with the higher reading used for future measurements. If the difference between the two arms is more than 20 mmHg for systolic pressure or 10 mmHg for diastolic pressure, the patient should be referred to the next level of care for examination for vascular stenosis. Patients with accelerated (malignant) hypertension (blood pressure 180/110 mmHg with papilloedema or retinal haemorrhages) or suspected secondary hypertension should be referred to the next level immediately. Risk stratification is not necessary for making treatment decisions for these individuals as they belong to the high risk category; all of them need intensive lifestyle interventions and appropriate drug therapy (5). Each chart has been calculated from the mean of risk factors and the average ten-year event rates from countries of the specific subregion. They are useful as tools to help identify those at high total cardiovascular risk, and to motivate patients, particularly to change behaviour and, when appropriate, to take antihypertensive and lipid-lowering drugs and aspirin. The mean of two non-fasting measurements of serum cholesterol by dry chemistry, or one nonfasting laboratory measurement, is sufficient for assessing risk. The strength of the various recommendations, and the level of evidence supporting them, are indicated as follows (13) in Table 5. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal Pa r t 2 2+ 2- 3 4 Non-analytical studies e. A body of evidence, including studies rated as 2++, is directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 1++ or 1+. A body of evidence, including studies rated as 2+, directly applicable to the target population and demonstrating overall consistency of results; or extrapolated evidence from studies rated as 2++. R e c om m e n dat i o n s When resources are limited, individual counselling and provision of care may have to be prioritized according to cardiovascular risk. All smokers should be strongly encouraged to quit smoking by a health professional and supported in their efforts to do so. Policy measures that create conducive environments for quitting tobacco, engaging in physical activity and consuming healthy diets are necessary to promote behavioural change. For individuals in low risk categories, they can have a health impact at lower cost, compared to individual counselling and therapeutic approaches. Total fat intake should be reduced to about 30% of calories, saturated fat intake should be limited to less than 10% of calories and trans-fatty acids eliminated. Individuals with persistent blood pressure 140/90 mmHg,e should continue life style strategies to lower blood pressure and have their blood pressure and total cardiovascular risk reassessed every two to five years depending on clinical circumstances and resource availability. However, applying this recommendation will lead to a large proportion of the adult population receiving antihypertensive drugs. Even in some high-resource settings, current practice is to recommend drugs for this group only if the blood pressure is at or above 160/100 mmHg. Individuals in this risk category should be advised to follow a lipid-lowering diet and given a statin. Even in some high-resource settings, current practice is to recommend drugs for this group only if serum cholesterol is above 8mmol/l (320 mg/dl). There are no clinical trials that have evaluated the absolute and relative benefits of cholesterol lowering to different cholesterol targets in relation to clinical events. For individuals in this risk category, the benefits of aspirin treatment are balanced by the harm caused. Best Practice point: Unless there are compelling indications to use a specific drug, the least expensive preparation of the above classes of drugs should be used. Modification of behaviour There is little controversy over the benefits to cardiovascular health of not smoking, eating a well balanced diet, maintaining mental well-being, taking regular exercise and keeping active, as demonstrated in large cohort studies. These health behaviours also play an etiological role in other noncommunicable diseases, such as cancer, respiratory disease, diabetes, osteoporosis and liver disease (86), which makes interventions to promote them potentially very cost-effective. Behaviours such as stopping smoking, taking regular physical activity and eating a healthy diet promote health and have no known harmful effects. They also improve the sense of well-being and are usually less expensive to the health care system than drug treatments, which may also have adverse effects. Further, while effects of drug therapy cease within a short period of discontinuation of treatment the impact of life style modification if it is maintained are longer standing. A variety of lifestyle modifications have been shown, in clinical trials, to lower blood pressure (89, 90).
A three to six month sample of healthcare resource use would provide significantly better statistical control medicine vocabulary order 250mg chloroquine mastercard. There is inherent potential for error in using such a model rather than using actual costs symptoms 4dp5dt cheap 250mg chloroquine fast delivery, and evidence of such error is included in the report medicine hat horse chloroquine 250 mg without prescription. Of the two remaining demonstration participants medications mobic order chloroquine 250 mg with mastercard, both have seen improved utilization and cost results in the last two years, and a final evaluation at the end of the program will allow the renal community to maximize its learning from this important experiment. In addition, we are working with an independent evaluator to reanalyze the current data and to conduct a final evaluation of the entire five-year demonstration, using the robust analytical approaches we believe are essential to producing the most accurate and appropriate conclusions on the clinical and financial outcomes of this project. Additional analysis of the experience during the last two years of the Demonstration period might provide insights not observed during the first three years. Therefore, the analytical methodology used several patient groups to serve as comparisons to the selected Disease Management interventions. These comparison groups were identified in order to be similar to the Demonstration groups, subject to availability of data. Some analyses utilized geographic-matched comparison populations, and others used a propensityscore matched comparison population. For analyses evaluating the impact of Disease Management on processes of care, we accessed the United States Dialysis Outcomes Practice Patterns Study (U. Altogether, these methods for comparing the intervention group to a comparison population allowed for the evaluation of multiple endpoints including processes of care, clinical outcomes, service utilization, patient-centered measures, and financial outcomes. Finally, we utilized analytical tools that took into account clinical and demographic factors that would be expected to impact findings for the respective endpoints evaluated. The Evaluation Report notes both strengths and potential limitations for interpreting the findings, such as differential disenrollment rates, and limitations of the propensity score methodology. However, it is also necessary to draw the most accurate conclusions possible from the existing data recognizing the potential uncertainties in those conclusions. Many different specific methodologies could have been used in this demonstration evaluation, as in the general analysis of research questions. As described below, multiple methods were used to test several of the research questions. In these instances, the different methods yielded consistent results, suggesting that the results are relatively robust to the method used to carry out the analysis. Various clinical and demographic factors were taken into account in the propensity score method. However, the actual matching process is based on the overall "propensity score" rather than on individual clinical and demographic factors. We clarify that propensity score matching did not "fail" as demonstrated by the improvement of standardized differences post-matching on nearly all variables (see details provided in the Technical Appendix). Our examination of the improvement in comparability of propensity score matched populations shows reduced bias overall and is consistent with published literature evaluating success of the propensity score matching process [1]. In summary, while there is some evidence for residual differences in the groups, there does not appear to be evidence for a large amount of remaining confounding. Nonetheless, we have included supporting analyses and substantial text on these issues in the report. These models provide for direct statistical adjustment for characteristics that continued to differ after the propensity score methodology. While these models are inherently limited Arbor Research Collaborative fo r Health 144 Final Report Appendices by application after the propensity score methodology, there is no reason to believe these models failed to statistically adjust for observed residual differences. Regarding controlling for baseline healthcare resource utilization: One important control used in the analysis was to adjust for baseline levels. Measuring baseline utilization over a longer time period has the potential to improve the accuracy of the propensity score models for some patients. However, use of a longer baseline period would not be expected to reduce bias in the results but would primarily increase precision in the estimates. In this case, using a longer baseline period might improve the accuracy of the baseline adjustment for those patients included in the analysis, but at the expense of possibly excluding more patients from the analysis. Furthermore, there are concerns about the endogeneity of measuring baseline utilization after an implicit decision is made by patients not to enroll in the Demonstration. Although it is possible that results from future studies might lead to different conclusions than were reached in our analyses of existing data at the 3-year time-point, the use of multiple methods that yielded consistent results suggests conclusions robust to any particular method. In addition it is important to recognize the uncertainties resulting from any non-randomized study. We believe that advances in understanding are most reliable when based on replicated and iterative studies of important issues. Case Studies and Practice Questions the case studies and questions have been written by content experts. Then in Section 5, starting on page 35, you will find each correct answer written out, with a rationale explaining the reason for the answer. William Day, a 65-year-old retired laborer, was diagnosed with proteinuria 10 years ago. It will decrease diffusion of urea across the blood brain barrier, reducing the possibility of cerebral edema. Individualizing the care for those with kidney disease: Patient and family education. For this patient, the level of the medication in his blood is diminishing as his dialysis session continues; the result is a rise in blood pressure. Drug Prescribing in Kidney Disease: Initiative for Improved Dosing Effects of impaired kidney function on drug pharmacokinetics and pharmacodynamics Section Leaders: William Bennett and Domenic Sica Kidney Disease: Improving Global Outcomes This factor is the ratio of the half-life of the drug in the patient to the halflife of the drug in the normal person Kidney Disease: Improving Global Outcomes Digital Health Center, Hasso Plattner Institute, University of Potsdam, Professor-Dr. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation. The Mount Sinai Institutional Review Board approved this research under a broad regulatory protocol allowing for analysis of patient-level data. Racial groups included White, Black or African American, Asian, Pacific Islander, Other, and Unknown. Vital signs and laboratory values during the first 48 hours of admissions that were obtained as part of indicated clinical care were included. Definitions of Pre-existing Conditions We defined a pre-existing conditions as the presence of diagnosis codes associated with specific diseases as per the Elixhauser Comorbidity Software. The need for acute dialysis was ascertained by procedure codes and was cross-referenced with nursing flow sheets. Statistical Analysis Baseline characteristics were reported as medians and interquartile ranges or means and standard deviations, for continuous variables. Features inputted into the model included demographics, laboratory values, and vital signs that occurred in the first 48 hours of admission. Other variables were statistically significant but likely not clinically significant given small absolute differences. Creatinine trends by recovery group are presented in Figure 3 A, B and C for differing subsets of the population. The features that had a larger impact on the model included serum creatinine, age, potassium, and heart rate (Figure 4). Several features found to have a big effect on model performance included creatinine, age, and potassium. Lastly, baseline medications of interest including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins, and other nonsteroidal anti-inflammatory drugs were not included. Acknowledgements: To all the nurses, physicians, and providers who contributed to the care of these patients. An Overlooked, Possibly Fatal Coronavirus Crisis: A Dire Need for Kidney Dialysis. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome.
Factors contributing to poor adherence are myriad medications j-tube buy generic chloroquine 250mg on-line, complex medications given for bipolar disorder purchase chloroquine 250mg, and multilevel (11 medicine prices 250mg chloroquine visa, 13 medicine engineering discount 250 mg chloroquine fast delivery, 14). Therefore, solutions to improve adherence may be introduced at patient, provider, and healthcare system levels (13, 15, 16). Several systematic reviews and meta-analyses have assessed the impact of interventions on adherence to antihypertensive medications, including modification of antihypertensive therapy (1-7, 11, 15, 16). No single intervention is uniquely effective, and a sustained, coordinated effort that targets all barriers to adherence in an individual is likely to be the most effective approach. See Online Data Supplement F for barriers to medication adherence and the most successful interventions. The creation of an encouraging, blame-free environment in which patients are recognized for achieving treatment goals and given "permission" to answer questions related to their treatment honestly is essential to identify and address nonadherence. Patient medication adherence assessment tools (17) are presented in Online Data Supplement A. Members of the hypertension care team may use these self-report tools in a nonthreatening fashion to identify barriers and facilitate behaviors associated with improved adherence to antihypertensive medications. Remembering to take medication is often challenging, particularly for regimens that must be dosed several times daily. Taking medications several times throughout the day requires greater attention to scheduling, as well as additional issues such as transportation or storage, which can be challenging for some patients. The impact of once-daily dosing of antihypertensive drugs versus dosing multiple times daily has been evaluated in several meta-analyses (1-3). Medication adherence was greatest with once-daily dosing (range 71% to 94%) and declined as dosing frequency increased (1, 2). Assessment and possible modification of drug therapy regimens can improve suboptimal adherence. Available fixed-dose combination drug therapy is listed in Online Data Supplement D. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta-analysis. Recommendations for Antihypertensive Medication Adherence Strategies Downloaded from hyper. How can we improve adherence to blood pressure-lowering medication in ambulatory care? Single-pill vs free-equivalent combination therapies for hypertension: a metaanalysis of health care costs and adherence. Identifying barriers to hypertension care: implications for quality improvement initiatives. Evaluation of adherence should become an integral part of assessment of patients with apparently treatment-resistant hypertension. Evidence-based interventions to improve patient compliance with antihypertensive and lipid-lowering medications. Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Strategies to Promote Lifestyle Modification References that support the recommendation are summarized in Online Data Supplement 61. Effective behavioral and motivational strategies to achieve a healthy lifestyle (i. These modifications are central to good health and require specific motivational and cognitive intervention strategies designed to promote adherence to these healthy behaviors. High-quality evidence supporting some of these strategies is provided in Online Data Supplement G. Additionally, interventions such as goal setting, provision of feedback, self-monitoring, follow-up, motivational interviewing, and promotion of self-sufficiency are most effective when combined. Other factors that may influence adoption and maintenance of new physical activity or dietary behaviors include age, sex, baseline health status, and body mass index, as well as the presence of comorbid conditions and depression, which negatively affect adherence to most lifestyle change regimens (1). Primary strategies include cognitive-behavioral strategies for promoting behavior change, intervention processes and delivery strategies, and addressing cultural and social context variables that influence behavioral change. It is crucial to translate and implement into practice the most effective evidence-based strategies for adherence to nonpharmacological treatment for hypertension. Success requires consideration of race, ethnicity, and socioeconomic status, as well as individual, provider, and environmental factors that may influence the design of such interventions (1). Because many beneficial effects of lifestyle changes accrue over time, long-term adherence maximizes individual and population benefits. Interventions targeting sodium restriction, other dietary patterns, weight reduction, and new physical activity habits often result in impressive rates of initial behavior changes but frequently are not translated into long-term behavioral maintenance. Improving Quality of Care for Resource-Constrained Populations the availability of financial, informational, and instrumental support resources can be important though not sole determinants of hypertension control (1, 2). The management of hypertension in resource-constrained populations poses a challenge that will require the implementation of all recommendations discussed in Section 13 (Table 21), with specific sensitivity to challenges posed by limited financial resources, including those related to health literacy, alignment of and potential need to realign healthcare priorities by patients, the convenience and complexity of the management strategy, accessibility to health care, and health-related costs (including medications). Resource-constrained populations are also populations with high representation of groups most likely to manifest health disparities, including racial and ethnic minorities (see Section 10. It is crucial to invest in measures to enhance health literacy and reinforce the importance of adhering to treatment strategies, while paying attention to cultural sensitivities. These measures may include identification of and partnering with community resources and organizations devoted to hypertension control and cardiovascular health. Where appropriate, using scored tablets and pill cutters can decrease the cost of medication for patients. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension. Health coaching to improve hypertension treatment in a lowincome, minority population. Cost-effectiveness of a physician-pharmacist collaboration intervention to improve blood pressure control. Structured, Team-Based Care Interventions for Hypertension Control Recommendation for Structured, Team-Based Care Interventions for Hypertension Control References that support the recommendation are summarized in Online Data Supplement 62. A team-based care approach is patient centered and is frequently implemented as part of a multifaceted approach, with systems support for clinical decision making (i. These professionals complement the activities of the primary care provider by providing process support and sharing the responsibilities of hypertension care. Section 13 contains a comprehensive, patient-centered plan of care that should be the basis of all team-based care for hypertension. Team-based care aims to achieve effective control of hypertension by application of the strategies outlined in Online Data Supplement H (3). Team member roles should be clear to all team members and to patients and families. Team-based care often requires organizational change and reallocation of resources (14, 15). Team-based care and improved blood pressure control: a community guide systematic review. Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes: Resource Guide. The role of the clinical pharmacist in the care of patients with cardiovascular disease. Such innovations are implemented as ongoing quality improvement initiatives in clinical practice. A technology-based quality innovation to identify undiagnosed hypertension among active primary care patients. Telehealth Interventions to Improve Hypertension Control References that support the recommendation are summarized in Online Data Supplement 64.
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