Family Medicine

High engagement in remote BP monitoring improves hypertension control across diverse patients

This retrospective cohort included 835 adults with hypertension in an urban academic RPM program with at least six months of follow-up. About 62% achieved high engagement, measuring BP on more than half of days in at least two of the first three months. Engagement was similar across gender, race/ethnicity, and preferred language, indicating broad feasibility in diverse primary care populations. Older age and lower baseline systolic BP predicted higher engagement, suggesting younger and more uncontrolled patients may need added support. High-engagement participants had 83% higher adjusted odds of achieving BP <140/90 mmHg at six months than low-engagement participants. 1

Primary care involvement for dialysis patients lowers ED utilization

This national cross-sectional study analyzed 181,520 Medicare hemodialysis patients treated between 2018 and 2019. Using differential distance as an instrumental variable, primary care involvement was linked to fewer ED visits not resulting in hospitalization. Estimated risk of a non-hospitalized ED visit was about 51% with primary care versus 72% without primary care involvement. Overall ED visit risk was also lower with primary care engagement, while hospitalization risk was similar between groups. Findings support ongoing primary care participation in ESKD care to manage ambulatory-sensitive issues outside the ED. 2

Many guideline-eligible adults remain undertreated with statins even after considering preferences

This modeling study applied previously derived treatment preference proportions to NHANES 2013-2020 data. Investigators estimated that 22.4 million additional US adults would be guideline-eligible for primary-prevention lipid-lowering therapy. Of these, 7.8 million would both meet guideline criteria and likely prefer treatment based on modeled preferences. Results indicate that true patient preference explains only a fraction of observed underuse of lipid-lowering therapy among eligible adults. 3

Polypharmacy and hyperpolypharmacy remain common and expensive in older US adults

Using 2002-2017 MEPS data, authors studied 61,402 adults aged 65 or older, representing 643 million person-years. Polypharmacy prevalence (5-9 medications) ranged from roughly 35% to 39%, and hyperpolypharmacy (≥10 medications) from 12.5% to 17.7%. Polypharmacy increased until 2011 then declined modestly, whereas hyperpolypharmacy rose until 2006 and then remained stable. Burden was highest among adults aged 75-84 years and among women, with particularly rising polypharmacy among Asians. After 2013, healthcare expenditures rose for patients with polypharmacy, and medication costs increased significantly for those with hyperpolypharmacy. These findings reinforce the need for regular medication review and deprescribing efforts in older primary care patients. 4