Search

Background Hypertension guidelines recommend screening and treatment for masked hypertension (MHT). Yet, few primary care providers (PCPs) screen for MHT, and little is known about PCP awareness, knowledge, and attitudes toward MHT. Methods Three focus groups involving 30 PCPs from 3 medical centers in New York were conducted. Focus group transcripts were analyzed using thematic content analysis. Results Awareness of MHT varied, and only 2 providers had diagnosed MHT. There was also low knowledge about the prevalence and impact of MHT. While some PCPs were receptive to MHT screening after learning about its significance, others viewed the current evidence as insufficient to change practice. Providers were discomforted by labeling patients with nonelevated office blood pressure (BP) as hypertensive and reluctant to add another screening test to their workload without stronger evidence. There was distrust in the accuracy of home BP monitoring to screen for MHT. There was more confidence in ambulatory BP monitoring (ABPM) for MHT screening, but ABPM was viewed as largely inaccessible. There was broad agreement with lifestyle changes for MHT. There were concerns that antihypertensive medication lacked evidence from randomized trials and could induce harmful side effects. Conclusions Limited PCP knowledge about MHT, concerns about the accuracy and accessibility of screening tests, overloaded PCPs, and insufficient evidence were major barriers to screening and treatment for MHT. Prior to broad uptake by PCPs, randomized trials demonstrating the net benefits of MHT screening and treatment may be needed, along with increased dissemination of knowledge about MHT and improved access to ABPM. [ABSTRACT FROM AUTHOR]

The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. We characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. This was a cross-sectional web survey of physicians, advanced practice providers, residents/fellows, and nurses, conducted during a peak of inpatient admissions for COVID-19 in NYC (April 9th–April 24th 2020) at a large medical center in NYC (n = 657). Positive screens for psychological symptoms were common; 57% for acute stress, 48% for depressive, and 33% for anxiety symptoms. For each, a higher percent of nurses/advanced practice providers screened positive vs. attending physicians, though housestaff's rates for acute stress and depression did not differ from either. Sixty-one percent of participants reported increased sense of meaning/purpose since the COVID-19 outbreak. Physical activity/exercise was the most common coping behavior (59%), and access to an individual therapist with online self-guided counseling (33%) garnered the most interest. NYC HCWs, especially nurses and advanced practice providers, are experiencing COVID-19-related psychological distress. Participants reported using empirically-supported coping behaviors, and endorsed indicators of resilience, but they also reported interest in additional wellness resources. Programs developed to mitigate stress among HCWs during the COVID-19 pandemic should integrate HCW preferences. [ABSTRACT FROM AUTHOR]