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Screening for hypertension by optometrists

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Abstract

This report describes a successful program for training optometrists in hypertension detection and presents preliminary results of screening 14,000 patients.

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Problems with patient screening, disease labeling, diagnosis confirmation, patient compliance and physician adherence continue to undermine efforts to control hypertension and prevent its complications.Simple screening involves patient selection bias, limited new diagnosis, arterial pressure lability, ambiguous disease definition, complex measurement imprecision and deficient patient follow-through. Case finding may improve some of these deficiencies. Recent data suggest that labeling a person as hypertensive may produce impaired self-concept, marital dissatisfaction and absence from work. Newer series confirm the low prevalence of curable, secondary hypertension among unselected patients and strongly argue for restricting extensive hypertensive evaluations to selected subpopulations. Patient noncompliance is highly prevalent, poorly predicted and imprecisely measured. Based on successful trials, specific suggestions can be made to achieve maximum patient compliance and physician adherence to diagnostic and therapeutic guidelines.
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All 319 participants of an intensive continuing education course on optometric hypertension screening at the University of Alabama at Birmingham were surveyed 5 years after completion of the course. Almost 85 percent of 211 responding optometrists reported that they were continuing to screen for hypertension in their practices. They estimated that 24 percent of their patients had hypertension and that of these 11 percent were previously undetected. The criteria used by these optometrists for tentative diagnosis and referral were consistent with currently accepted guidelines. Hypertension screening by optometrists is cost-effective, and this survey suggests that continuing education courses providing intensive didactic and clinical instruction may be an effective method for changing clinicians' behavior. For most optometrists who participated in this continuing education program, the program appears to have positively changed their clinical behavior.
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To increase the usefulness of existing physician location literature for policy evaluation, literature is grouped into intraurban and urban-rural studies. A conceptual overview of physician location literature is presented. Consensus results, if any, are discussed. A list of hypotheses suggested by the literature is then utilized in a discussion of economic social, prior exposure, and professional development incentives embodied in selected public and private sector programs. Programs are evaluated by type of incentive mechanism and geographic target area to determine if present program structures are based on a solid empirical foundation. This assessment indicates that, in general, use of prevalent location incentive mechanisms is not justified by a consensus of empirical evidence.
Optometrists, like all health care providers, should emphasize primary or preventive care. To provide this care optometrists must be aware of the risk factors for major causes of mortality. As an example, the risk profile for a white male age 45 to 49 years is given and discussed. Suggestions for primary vision care and detection of major risk factors by optometrists are also presented.
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At your meeting three years ago, I discussed the supply of physicians' services and made some references to our study of the distribution of physicians by medical service areas. This study, started in 1947, is nearing completion and should be published in April of this year as Bulletin 94, "Distribution of Physicians by Medical Service Areas." In this paper I will present a brief sketch of the two score conclusions of this study. In a sense, this paper is an extension of the one I gave three years ago, which was published in The Journal (145: 1260 [April 21] 1951). Some of you may recall that I featured my home county?Pike County, Illinois. The number of physicians in that county declined from 42 to 16 in a generation, and the population decreased from 27,000 in 1920 to 22,000 in 1950. Yet this smaller number of physicians today is providing more
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