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Culturally Sensitive Care for African Americans and Hispanics in the Treatment of Diabetes and Hypertension
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Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by
the
University
of
Alabama
School
of
Medicine
Division of Continuing Medical Education
and
Alabama Quality Assurance Foundation
| 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,
physicians and other healthcare professionals
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.
- To understand the need for a translator and list the effective steps to use a translator.
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| SOURCE: |
| FACULTY: |
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Carlos
Estrada, MD
Associate Professor of Medicine
University of Alabama at Birmingham
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| Top of Page |
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| DISCLOSURE: |
The
faculty discloses grants/research
support from the NIH: NHLBI and
honoraria from ACP
Medicine - Institute for Healthcare
Education.
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™.
Physicians should only claim credit
commensurate with the extent of
their participation in the activity.
The
boards of nursing in many states,
including Alabama, 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.
UAB is an equal opportunity/affirmative
action institution. |
| INTRODUCTION: |
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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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