No abstract

In 2012, the Centers for Medicare & Medicaid Services (CMS) instituted a Physician Quality Reporting System measure for screening and referring patients with elevated blood pressure (BP). The aims of this study were to (1) assess the reliability of ED triage BP as a metric to establish when the CMS threshold (≥120/80 mm Hg), and other clinically relevant BP thresholds (≥140/90 and ≥160/100 mm Hg) have been met, using BP measured with a highly accurate device (BpTRU) in the emergency department as the gold standard; and (2) determine whether correct identification varies by gender, race, or triage acuity. Using the BpTRU, we calculated the proportion of patients whose triage BP accurately indicated a need for further referral and treatment for hypertension according to three suggested BP thresholds (≥120/80, ≥140/90, and ≥160/100 mm Hg). Of 354 patients, the median age was 39 years, 48.9% were women, and 66.4% were White. At the three suggested BP thresholds (≥120/80, ≥140/90, and ≥160/100 mm Hg), 66.1%, 74.0%, and 88.8% of patients were confirmed to meet the CMS threshold, respectively. There were no differences by gender, race, or triage acuity. Emergency department triage BP would reliably identify elevated BP using the CMS threshold in up to two-thirds of those without known hypertension.

Objectives: Schizophrenia is a chronic mental health disorder commonly managed with antipsychotic medications. This qualitative study explored treatment experiences with oral antipsychotic medications in individuals with a self-reported diagnosis of schizophrenia. Methods: Three 90-minute focus groups were conducted with five participants in each group (total N=15). Each group had two trained moderators facilitating the discussion using a semi-structured guide. The guide was reviewed and approved by expert clinicians, patient advocates, and an independent review board. Participants described their experiences with oral antipsychotic treatments, including positive and burdensome effects of treatment. Results: The sample was diverse in terms of demographics (e.g., 53% male; 33% Caucasian), time since initial diagnosis (3 to 40 years), and past and current treatment experiences. Participants described various aspects of effective treatment including relief from paranoia (n=8; 53%), feeling calmer and more balanced (n=6; 40%), and increased mental focus and concentration (n=3; 20%). Participants discussed a range of success with current treatments, with 8 (53%) describing their treatment as having been overall successful. Most participants reported discontinuing an antipsychotic medication at some point (n=13; 87%) and switching to a different treatment to avoid side effects or achieve better symptom control (n=13; 87%). The 15 participants described a variety of side effects; most common were weight gain (n=12; 80%), drowsiness (n=4; 27%), sexual problems (n=4; 27%), and tremors/ticks (n=4; 27%). Those participants who experienced weight gain reported gaining between 50 to 100 pounds. Conclusions: In these focus groups, approximately half of participants reported medications as successful in managing symptoms. Participants reported burdensome side effects with prior or current medications, which often led to modifying their treatment regimen. Findings from this study provide a deeper understanding of treatment experiences of patients with schizophrenia and highlight a need for new medications with more favorable benefit/risk profiles.