دورية أكاديمية
Resident-led improvement project to screen for primary hyperaldosteronism in patients with resistant hypertension in an outpatient clinic.
| العنوان: | Resident-led improvement project to screen for primary hyperaldosteronism in patients with resistant hypertension in an outpatient clinic. |
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| المؤلفون: | Anandasivam NS; Central Texas Veterans Affairs Health System, Austin, Texas, USA nidharshan17@gmail.com.; Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA., Vasudevan J; Central Texas Veterans Affairs Health System, Austin, Texas, USA.; Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA., Sadler H; Central Texas Veterans Affairs Health System, Austin, Texas, USA.; Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA., Moriates C; Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA., Pignone M; Central Texas Veterans Affairs Health System, Austin, Texas, USA.; Department of Internal Medicine, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA. |
| المصدر: | BMJ open quality [BMJ Open Qual] 2024 May 27; Vol. 13 (2). Date of Electronic Publication: 2024 May 27. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101710381 Publication Model: Electronic Cited Medium: Internet ISSN: 2399-6641 (Electronic) Linking ISSN: 23996641 NLM ISO Abbreviation: BMJ Open Qual Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BMJ Publishing Group |
| مواضيع طبية MeSH: | Hyperaldosteronism*/complications , Hyperaldosteronism*/diagnosis , Quality Improvement* , Hypertension*/drug therapy , Hypertension*/complications , Hypertension*/diagnosis , Mass Screening*/methods , Mass Screening*/standards , Mass Screening*/statistics & numerical data , Ambulatory Care Facilities*/organization & administration , Ambulatory Care Facilities*/statistics & numerical data, Humans ; Female ; Male ; Middle Aged ; Aged ; United States ; Internship and Residency/methods ; Internship and Residency/statistics & numerical data ; Internship and Residency/standards ; United States Department of Veterans Affairs/organization & administration ; United States Department of Veterans Affairs/statistics & numerical data |
| مستخلص: | Clinical practice guidelines recommend screening for primary hyperaldosteronism (PH) in patients with resistant hypertension. However, screening rates are low in the outpatient setting. We sought to increase screening rates for PH in patients with resistant hypertension in our Veterans Affairs (VA) outpatient resident physician clinic, with the goal of improving blood pressure control. Patients with possible resistant hypertension were identified through a VA Primary Care Almanac Metric query, with subsequent chart review for resistant hypertension criteria. Three sequential patient-directed cycles were implemented using rapid cycle improvement methodology during a weekly dedicated resident quality improvement half-day. In the first cycle, patients with resistant hypertension had preclinic PH screening labs ordered and were scheduled in the clinic for hypertension follow-up. In the second cycle, patients without screening labs completed were called to confirm medication adherence and counselled to screen for PH. In the third cycle, patients with positive screening labs were called to discuss mineralocorticoid receptor antagonist (MRA) initiation and possible endocrinology referral. Of 97 patients initially identified, 58 (60%) were found to have resistant hypertension while 39 had pseudoresistant hypertension from medication non-adherence. Of the 58 with resistant hypertension, 44 had not previously been screened for PH while 14 (24%) had already been screened or were already taking an MRA. Our screening rate for PH in resistant hypertension patients increased from 24% at the start of the project to 84% (37/44) after two cycles. Of the 37 tested, 24% (9/37) screened positive for PH, and 5 patients were started on MRAs. This resident-led quality improvement project demonstrated that a focused intervention process can improve PH identification and treatment. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.) |
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| فهرسة مساهمة: | Keywords: PDSA; Quality improvement; Quality improvement methodologies |
| تواريخ الأحداث: | Date Created: 20240527 Date Completed: 20240527 Latest Revision: 20240530 |
| رمز التحديث: | 20240530 |
| مُعرف محوري في PubMed: | PMC11131109 |
| DOI: | 10.1136/bmjoq-2023-002611 |
| PMID: | 38802267 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2399-6641 |
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| DOI: | 10.1136/bmjoq-2023-002611 |