Clinical inertia, either diagnostic or therapeutic, was present in one of every three cases of high BP. The most frequent factors associated with clinical inertia were the presence of associated conditions, which requires lower BP goals and the BP values.
Background
Patient experience is acknowledged as a principal aspect of quality healthcare delivery, and it has implications with regard to outcomes.
Objectives
Our objective was to evaluate the healthcare experience of patients with chronic diseases to identify patient-perceived healthcare gaps and to assess the influence of demographic and healthcare-related variables on patient experiences.
Methods
A cross-sectional survey was delivered to adult patients with chronic diseases: diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, inflammatory bowel disease (IBD) or rheumatic diseases. Patient experiences were assessed with the Instrument for Evaluation of the Experience of Chronic Patients (IEXPAC) questionnaire, with possible scores ranging from 0 (worst) to 10 (best experience).
Results
Of the 2474 patients handed the survey, 1618 returned it (response rate 65.4%). Patients identified gaps in healthcare related mainly to access to reliable information and services, interaction with other patients and continuity of healthcare after hospital discharge. The mean ± standard deviation (SD) IEXPAC score was 6.0 ± 1.9 and was higher for patients with HIV (6.6 ± 1.7) than for those with rheumatic disease (5.5 ± 2.0), IBD (5.9 ± 2.0) or DM (5.9 ± 1.9) (
p
< 0.001). In multivariate models, better overall IEXPAC experience was associated with follow-up by the same physician, follow-up by a nurse, receiving healthcare support from others and treatment with subcutaneous or intravenous drugs. The multivariate model that confirmed patients with HIV or DM had better experience than did those with rheumatic diseases.
Conclusions
Through IEXPAC, patients identified aspects for healthcare quality improvements and circumstances associated with better experience, which may permit greater redirection of healthcare toward patient-centered goals while facilitating improvements in social care and long-term healthcare quality.
Electronic supplementary material
The online version of this article (10.1007/s40271-018-0345-1) contains supplementary material, which is available to authorized users.
on behalf of the investigators of the PREV-ICTUS Study Abstract-The objective was to assess the stroke risk and prevalence of the cardiovascular risk factors and to analyze their relationship with the specific stroke rates of mortality in each of the autonomic communities of Spain. We conducted a multicenter, cross-sectional study of population Ͼ60 years old in Spanish primary care centers. In all of the subjects, clinical, biochemical, and electrocardiographic data were obtained, and the 10-year stroke risk was calculated using the Framingham score.
In patients with UC, SCCAI self-administration via an online tool resulted in a high percentage of agreement with evaluation by gastroenterologists, with a remarkably high negative predictive value for disease activity. Remote monitoring of UC patients is possible and might reduce hospital visits.
In this cross-sectional study in an elderly population, body mass index and waist circumference showed an independent and direct impact on the prevalence of hypertension and on the absence of blood pressure control.
In hypertensive patients from primary care, the prevalence of cardiovascular disease is inversely proportional to the level of renal function. Estimated glomerular filtration is easy to determine and complements evaluation of the hypertensive patient.
on behalf of the investigators of the PREV-ICTUS study Background and Purpose-The objective of this study was to estimate the high blood pressure values and the 10-year risk of stroke in the Spanish general population aged 60 years or older using the Framingham scale. Methods-This was a multicenter, population-based, cross-sectional study performed in Spanish primary care centers. A randomized selection of centers and recruitment population was used. We collected clinical, biochemical, and electrocardiographic data. Results-We analyzed 7343 subjects (mean age, 71.6 years; standard deviation, 7.0; 53.4% females, 34.4% obese subjects, and 27.1% diabetic subjects). Electrocardiographic-left ventricle hypertrophy was present in 12.9% of the subjects, atrial fibrillation in 8.4%, and established cardiovascular disease in 28.9%; 73.0% already had hypertension diagnosed, and 12.8% showed high blood pressure without a prior diagnosis of hypertension. Among hypertensive subjects, 29.1% had high blood pressure on therapeutic objective, and of the total population 35.7% had high blood pressure under control. Those with hypertension already diagnosed showed a higher prevalence of other stroke risk factors (left ventricle hypertrophy, atrial fibrillation, diabetes, or established cardiovascular disease). The estimated 10-year stroke risk was 19.6% (standard deviation, 17.3%), and was greater in hypertensive patients (23.7%; standard deviation, 18.5) than in patients with high blood pressure without known hypertension (12.4%; standard deviation, 9.2), or in normotensive subjects (5.3%; standard deviation, 0.2; PϽ0.001). Conclusion-The 10-year estimated stroke risk was 19.6%, and it was greater in hypertensive patients as compared with the remainder people at any blood pressure range. The concomitant stroke risk factors are more prevalent in patients with hypertension already diagnosed, which implies an important additional estimated risk of stroke.
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