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Culturally Sensitive Care for African Americans and Hispanics in the Treatment of Diabetes and Hypertension |
Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by the University of Alabama School of Medicine
Division of Continuing Medical Education and
Information and Quality Healthcare
| Release
Date: May 4, 2007 |
Expiration
Date: May 4, 2010
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| TARGET
AUDIENCE: |
| Primary
care physicians |
| OBJECTIVES: |
Upon
completion of this CME activity, clinicians should
be able to:
- Recognize barriers for care among African-Americans with hypertension and to know their initial management.
- List the medications most effective to control hypertension among African-Americans.
- Know the high risk conditions that warrant screening for diabetes mellitus.
- Know the meaning of prejudice and stereotype.
- Use self-reflection to understand our own perceptions, biases, and stereotypes.
- Understand the need for a translator and list the effective steps to use a translator.
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| SOURCE: |
| FACULTY: |
Carlos
Estrada, MD
Associate Professor of Medicine
University of Alabama at Birmingham
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| DISCLOSURE: |
In
accordance with the Accreditation Council for
Continuing Medical Education Standards for Commercial
Support, Dr. Estrada discloses grants/research support from the NIH: NHLBI and honoraria from ACP Medicine - Institute for Healthcare Education. Dr. Estrada has agreed that if an
unlabeled or investigational use of a commercial
product was discussed, he would disclose it as
such.
Because of the nature of preliminary studies, some
products mentioned are unlabeled and investigational.
Dosages, indications, and methods of use of drugs
mentioned in this publication may reflect the experience
of the authors, clinical literature, or other resources.
Therefore, please see the full prescribing information
before using any licensed product mentioned. |
| CME
PARTICIPATION: |
| To
participate in this online course for CME credit,
please review the objectives before beginning
the program. Complete the course and the self-assessment
test before May 4, 2010 to receive CME credit.
Your certificate will then be available online.
This process should take approximately 1 hour. |
| ACCREDITATION: |
|
The University
of Alabama School of Medicine is accredited
by the Accreditation Council for Continuing
Medical Education to provide continuing medical
education for physicians.
The University
of Alabama School of Medicine designates this
educational activity for a maximum of 1 AMA
PRA Category 1 credit(s)™. Physicians
should only claim credit commensurate with
the extent of their participation in the activity.
The
boards of nursing in many states, including
Mississippi, recognize Category 1 continuing
medical education courses as acceptable activities
for the renewal of license to practice nursing.
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| DISCLAIMER: |
| Dosages,
indications, and methods of use of any drug referred
to in this publication may reflect the clinical
experience of the authors, clinical literature,
or other clinical resources. Therefore, please
see the full prescribing information before using
any product mentioned. |
| INTRODUCTION: |
Hypertension affects ~50 million Americans. Approximately 1 billion individuals have hypertension worldwide. Uncontrolled blood pressure is the number one attributable risk for death throughout the world. In the U.S., ~ 30% of adults are not unaware that they have hypertension, more than 40% of persons with hypertension are not on treatment, and in 2/3 of those treated, their BP is not controlled (<140/90 mm Hg).
- In African Americans, hypertension is more prevalent, more severe, develops at an earlier age, and leads to more complications than in whites.
- Mexican Americans and Native Americans have lower control rates than whites and African Americans. Mexican Americans and Cuban Americans have the lowest hypertension control rates (~14%).
Diabetes affects ~20 million Americans (7% of the U.S. population); over 90% are DM Type 2. Minorities are disproportionately affected by type 2 diabetes. Individuals born in 2000 have a 1 in 3 chance of developing diabetes during their lifetime (for Hispanic females, 1 in 2). Obesity is the most important factor in the increase of type 2 diabetes.
- African-Americans are 1.7 times more likely to have diabetes, have worse diabetes control, and more complications as compared to whites.
- Hispanics/Latinos are twice as likely to have and die from diabetes than whites.
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| Case
1: |
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A 48-year-old African-American woman comes to see you for routine follow up. She has no complaints. Her past medical history includes hypertension, obesity, and lactose intolerance. She is married, her husband works in agriculture, and they have 2 kids in high-school. She does not smoke or drink alcoholic beverages.
On physical examination, her blood pressure is 154/98mmHg, her pulse is 78/min, and her temperature is normal. Her BMI is 32. She does not have peripheral edema. Her cardiovascular exam shows normal neck veins, a non-enlarged heart, and a soft S4. She has no murmur.
On the prior visits her BP ranged between 145-160 and 92-102mm/Hg. Her most recent electrocardiogram shows left ventricular hypertrophy. Her laboratory exam done earlier today shows a normal hemoglobin, electrolytes, BUN/creatinine, urinalysis, and liver function tests.
On her last visit you advised her to lose weight and gave her a prescription for an angiotensin-receptor blocker. You also remember that you told her: “Let’s try this pill for your blood pressure. Let me know if you have any problems with it, and if it does not work, we will use something else.” |
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