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Hypertension: HELP
Articles by Kevin A. Fiscella
Based on 6 articles published since 2010
(Why 6 articles?)

Between 2010 and 2020, Kevin Fiscella wrote the following 6 articles about Hypertension.
+ Citations + Abstracts
1 Clinical Trial Theoretical and Pragmatic Adaptation of the 5As Model to Patient-Centered Hypertension Counselling. 2018

Carroll, Jennifer K / Fiscella, Kevin / Cassells, Andrea / Sanders, Mechelle R / Williams, Stephen K / D'Orazio, Brianna / Holder, Tameir / Farah, Subrina / Khalida, Chamanara / Tobin, Jonathan N. · ·J Health Care Poor Underserved · Pubmed #30122677.

ABSTRACT: Patient-centered communication is a means for engaging patients in partnership. However, patient centered communication has not always been grounded in theory or in clinicians' pragmatic needs. The objective of this report is to present a practical approach to hypertension counselling that uses the 5As framework and is grounded in theory and best communication practices.

2 Article Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States. 2018

Egan, Brent M / Li, Jiexiang / Davis, Robert A / Fiscella, Kevin A / Tobin, Jonathan N / Jones, Daniel W / Sinopoli, Angelo. ·Care Coordination Institute, Greenville, SC, USA. · Department of Medicine, University of South Carolina School of Medicine, Greenville, SC, USA. · Department of Mathematics, College of Charleston, Charleston, SC, USA. · Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA. · Clinical Directors Network (CDN), New York, NY, USA. · Center for Clinical and Translational Science, The Rockefeller University, New York, NY, USA. · Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA. · Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. · Department of Physiology & Biophysics, University of Mississippi Medical Center, Jackson, MS, USA. ·J Clin Hypertens (Greenwich) · Pubmed #29774988.

ABSTRACT: The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold (≥10.0% vs ≥7.5%) and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. Cross-sectional data on US adults aged 40 to 75 years enabled estimated numbers for the 2013 guideline and 2016 guideline with hypertension thresholds of ≥140/≥90 mm Hg and ≥130/80 mm Hg, respectively, on: (1) untreated, statin-eligible adults for primary atherosclerotic cardiovascular disease prevention (25.40, 14.72, 15.35 million); (2) atherosclerotic cardiovascular disease events prevented annually (124 000, 70 852, 73 199); (3) number needed to treat (21, 21, 21); and (4) number needed to harm (38, 143, 143) per 1000 patient-years for incident diabetes mellitus (42 800, 6700, 7100 cases per year). Despite the lower hypertension threshold, the 2013 cholesterol guideline qualifies approximately 10 million more adults for statins and prevents approximately 50 600 more primary atherosclerotic cardiovascular disease events but induces approximately 35 700 more diabetes mellitus cases annually than the 2016 guideline.

3 Article Addressing the Social Needs of Hypertensive Patients: The Role of Patient-Provider Communication as a Predictor of Medication Adherence. 2017

Schoenthaler, Antoinette / Knafl, George J / Fiscella, Kevin / Ogedegbe, Gbenga. ·From the Division of Health and Behavior, Department of Population Health, Center for Healthful Behavior Change, New York University (A.S., G.O.) · School of Nursing, University of North Carolina at Chapel Hill (G.J.K.) · and Department of Family Medicine, University of Rochester School of Medicine and Dentistry, NY (K.F.). ·Circ Cardiovasc Qual Outcomes · Pubmed #28830861.

ABSTRACT: BACKGROUND: Poor medication adherence is a pervasive problem in patients with hypertension. Despite research documenting an association between patient-provider communication and medication adherence, there are no empirical data on how the informational and relational aspects of communication affect patient's actual medication-taking behaviors. The aim of this study was to evaluate the impact of patient-provider communication on medication adherence among a sample of primary care providers and their black and white hypertensive patients. METHODS AND RESULTS: Cohort study included 92 hypertensive patients and 27 providers in 3 safety-net primary care practices in New York City. Patient-provider encounters were audiotaped at baseline and coded using the Medical Interaction Process System. Medication adherence data were collected continuously during the 3-month study with an electronic monitoring device. The majority of patients were black, 58% women, and most were seeing the same provider for at least 1 year. Approximately half of providers were white (56%), 67% women, and have been in practice for an average of 5.8 years. Fifty-eight percent of patients exhibited poor adherence to prescribed antihypertensive medications. Three categories of patient-provider communication predicted poor medication adherence: lower patient centeredness (odds ratio: 3.08; 95% confidence interval: 1.04-9.12), less discussion about patients' sociodemographic circumstances (living situation, relationship with partner; odds ratio: 6.03; 95% confidence interval: 2.15-17), and about their antihypertensive medications (odds ratio: 6.48; 95% confidence interval: 1.83-23.0). The effect of having less discussion about patients' sociodemographic circumstances on medication adherence was heightened in black patients (odds ratio: 8.01; 95% confidence interval: 2.80-22.9). CONCLUSIONS: The odds of poor medication adherence are greater when patient-provider interactions are low in patient centeredness and do not address patients' sociodemographic circumstances or their medication regimen.

4 Article Blood Pressure Visit Intensification Study in Treatment: Trial design. 2015

Fiscella, Kevin / Ogedegbe, Gbenga / He, Hua / Carroll, Jennifer / Cassells, Andrea / Sanders, Mechelle / Khalida, Chamanara / D'Orazio, Brianna / Tobin, Jonathan N. ·Department of Family Medicine, University of Rochester Medical Center, Rochester, NY. Electronic address: kevin_fiscella@urmc.rochester.edu. · Department of Population Health, Langone Medical Center, New York University, New York, NY. · Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. · Department of Family Medicine, University of Rochester Medical Center, Rochester, NY. · Clinical Directors Network (CDN), New York, NY. · Clinical Directors Network (CDN), New York, NY; Albert Einstein College of Medicine of Yeshiva University/Montefiore Medical Center, Bronx, NY; The Rockefeller University Center for Clinical and Translational Science, New York, NY. ·Am Heart J · Pubmed #26678642.

ABSTRACT: BACKGROUND: There is a presumption that, for patients with uncontrolled blood pressure (BP), early follow-up, that is, within 4 weeks of an elevated reading, improves BP control. However, data are lacking regarding effective interventions for increasing clinician frequency of follow-up visits and whether such interventions improve BP control. METHODS/DESIGN: Blood Pressure Visit Intensification Study in Treatment involves a multimodal approach to improving intensity of follow-up in 12 community health centers using a stepped wedge study design. DISCUSSION: The study will inform effective interventions for increasing frequency of follow-up visits among patients with uncontrolled BP and determine whether increasing follow-up frequency is associated with better BP control.

5 Article Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? 2011

Franks, Peter / Winters, Paul C / Tancredi, Daniel J / Fiscella, Kevin A. ·Center for Healthcare Policy and Research, University of California at Davis, University of California, Davis, 4860 Y Street, Suite 2300, Sacramento, California 95817, USA. pfranks@ucdavis.edu ·BMC Cardiovasc Disord · Pubmed #21639906.

ABSTRACT: BACKGROUND: Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether changes in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making. METHODS: The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables. RESULTS: Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to 1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to 1.74). CONCLUSION: Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.

6 Article A novel approach to quality improvement in a safety-net practice: concurrent peer review visits. 2010

Fiscella, Kevin / Volpe, Ellen / Winters, Paul / Brown, Melissa / Idris, Amna / Harren, Tricia. ·Department of Family Medicine, University of Rochester, New York, USA. kevin_fiscella@urmc.rochester.edu ·J Natl Med Assoc · Pubmed #21287904.

ABSTRACT: OBJECTIVE: Concurrent peer review visits are structured office visits conducted by clinician peers of the primary care clinician that are specifically designed to reduce competing demands, clinical inertia, and bias. We assessed whether a single concurrent peer review visit reduced clinical inertia and improved control of hypertension, hyperlipidemia, and diabetes control among underserved patients. METHODS: We conducted a randomized encouragement trial to evaluate concurrent peer review visits with a community health center. Seven hundred twenty-seven patients with hypertension, hyperlipidemia, and/or diabetes who were not at goal for systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and/or glycated hemoglobin (A1c) were randomly assigned to an invitation to participate in a concurrent peer review visit or to usual care. We compared change in these measures using mixed models and rates of therapeutic intensification during concurrent peer review visits with control visits. RESULTS: One hundred seventy-one patients completed a concurrent peer review visit. SBP improved significantly (p < .01) more among those completing concurrent peer review visits than among those who failed to respond to a concurrent peer review invitation or those randomized to usual care. There were no differences seen for changes in LDL-C or A1c. Concurrent peer review visits were associated with statistically significant greater clinician intensification of blood pressure (p < .001), lipid (p < .001), and diabetes (p < .005) treatment than either for control visits for patients in either the nonresponse group or usual care group. CONCLUSIONS: Concurrent peer review visits represent a promising strategy for improving blood pressure control and improving therapeutic intensification in community health centers.