Primary Aldosteronism.

Primary aldosteronism is the underlying cause of hypertension in primary care settings in approximately 6% of cases, and it is even more common in patients with resistant hypertension. However, it is estimated that only about 2% of patients who have risk factors for primary aldosteronism have been formally tested or diagnosed. The first step in the diagnosis of primary aldosteronism is case detection and involves testing patients who are at risk, including individuals with resistant hypertension, as well as those with well-controlled hypertension and a first-degree relative with primary aldosteronism, hypokalemia, an adrenal nodule, atrial fibrillation, obstructive sleep apnea, or a family history of an early stroke (i.

Redesigning the regulatory framework for ambulatory care services in New York.

Unlabelled: Policy Points: The landscape of ambulatory care services in the United States is rapidly changing on account of payment reform, primary care transformation, and the rise of convenient care options such as retail clinics. New York State has undertaken a redesign of regulatory policy for ambulatory care rooted in the Triple Aim (better health, higher-quality care, lower costs)-with a particular emphasis on continuity of care for patients. Key tenets of the regulatory approach include defining and tracking the taxonomy of ambulatory care services as well as ensuring that convenient care options do not erode continuity of care for patients.

Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force.

Background: In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend thyroid screening.

Perceptions of shared decision making and decision aids among rural primary care clinicians.

Background: Shared decision making (SDM) and decision aids (DAs) increase patients' involvement in health care decisions and enhance satisfaction with their choices. Studies of SDM and DAs have primarily occurred in academic centers and large health systems, but most primary care is delivered in smaller practices, and over 20% of Americans live in rural areas, where poverty, disease prevalence, and limited access to care may increase the need for SDM and DAs.

Objective: To explore perceptions and practices of rural primary care clinicians regarding SDM and DAs.

What is the best surveillance for hepatocellular carcinoma in chronic carriers of hepatitis B?

Screening patients with chronic hepatitis B infection (HBsAg+) for hepatocellular carcinoma by alpha-fetoprotein (AFP) or by AFP plus ultrasound (AFP/US) detects hepatocellular carcinoma tumors at earlier stages and increases resection rates (strength of recommendation [SOR]: B, based on a systematic review of fair-quality randomized controlled trials). It is unclear whether screening with AFP or AFP/US improves disease-specific or all-cause mortality (SOR: B).

Travel-related savings through a rural, clinic-based automated drug dispensing system.

For rural patients, access to pharmacies is often impeded by geographical and financial factors. The number of available pharmacies may be limited, and the extensive travel needed to access them is time consuming, potentially dangerous and, due to rising fuel prices, increasingly expensive. We describe the benefits of a clinic-based, automated medication dispensing system (ADDS) implemented in two rural communities in the Adirondack Mountain region of New York State.