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Public Health, Hypertension, and the Emergency Department

  • Hypertension and Emergency Medicine (T Rainer, Section Editor)
  • Published:
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Abstract

Hypertension (HTN) is the most common cardiovascular disease worldwide and is associated with severe long-term morbidity when not treated appropriately. Despite this, blood pressure (BP) control remains suboptimal, particularly among underserved populations and those who rely on emergency departments (EDs) as a source of primary care. ED providers encounter patients with severely elevated BP daily, and yet adherence to minimal standards of BP reassessment and referral to outpatient medical care, as recommended by the American College of Emergency Physicians, is limited. Barriers such as provider knowledge deficits, resource constraints, and negative attitudes towards patients who utilize EDs for nonurgent complaints are compounded by perceptions of HTN as a condition that can only be addressed in a primary care setting to contribute to this. Efforts to reduce this gap must go beyond government mandates to address systemic issues including access to care and payment models to encourage health promotion. Additionally, individual physician behavior can be shifted through targeted education, financial incentives, and the accumulation of high-quality evidence to encourage more proactive approaches to the management of uncontrolled HTN in the ED.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360. doi:10.1161/CIR.0000000000000350. The most recent update of the annual review of heart disease and stroke statistics, published by the American Heart Association. This review is the definitive source for national level data, and relies heavily on national, population weighted surveys, rather than regional samples.

    Article  PubMed  Google Scholar 

  2. Yoon SS, Gu Q, Nwankwo T, Wright JD, Hong Y, Burt V. Trends in blood pressure among adults with hypertension: United States, 2003 to 2012. Hypertension. 2015;65(1):54–61. doi:10.1161/HYPERTENSIONAHA.114.04012.

    Article  CAS  PubMed  Google Scholar 

  3. Center for Medicaid and Medicare Services, US Department of Health and Human Services. 2016 Cross cutting measure set. In: Services CfMaM, editor. 2016. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2016_PQRS-Crosscutting.pdf?yes&next=Accept. Accessed 11 April 2016.

  4. Gillespie CD, Hurvitz KA, (CDC). Prevalence of hypertension and controlled hypertension—United States, 2007–2010. MMWR Suppl. 2013;62(3):144–8.

    PubMed  Google Scholar 

  5. Giles T, Aranda JM, Suh DC, Choi IS, Preblick R, Rocha R, et al. Ethnic/racial variations in blood pressure awareness, treatment, and control. J Clin Hypertens (Greenwich). 2007;9(5):345–54.

    Article  Google Scholar 

  6. Flack JM, Ferdinand KC, Nasser SA. Epidemiology of hypertension and cardiovascular disease in African Americans. J Clin Hypertens (Greenwich). 2003;5(1 Suppl 1):5–11.

    Article  Google Scholar 

  7. Flack JM, Sica DA, Bakris G, Brown AL, Ferdinand KC, Grimm RH, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension. 2010;56(5):780–800. doi:10.1161/HYPERTENSIONAHA.110.152892.

    Article  CAS  PubMed  Google Scholar 

  8. Cutler JA, Sorlie PD, Wolz M, Thom T, Fields LE, Roccella EJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension. 2008;52(5):818–27. doi:10.1161/HYPERTENSIONAHA.108.113357.

    Article  CAS  PubMed  Google Scholar 

  9. Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol. 2015;31(5):569–71. doi:10.1016/j.cjca.2015.01.009.

    Article  PubMed  Google Scholar 

  10. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60. doi:10.1016/S0140-6736(12)61766-8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013;310(9):959–68. doi:10.1001/jama.2013.184182.

    Article  CAS  PubMed  Google Scholar 

  12. Gaziano TA, Bitton A, Anand S, Weinstein MC. The global cost of nonoptimal blood pressure. J Hypertens. 2009;27(7):1472–7. doi:10.1097/HJH.0b013e32832a9ba3.

    Article  CAS  PubMed  Google Scholar 

  13. D’Agostino RB, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53. doi:10.1161/CIRCULATIONAHA.107.699579.

    Article  PubMed  Google Scholar 

  14. Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(9):873–98. doi:10.1161/CIR.0000000000000228.

    Article  PubMed  Google Scholar 

  15. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111(10):1233–41. doi:10.1161/01.CIR.0000158136.76824.04.

    Article  PubMed  Google Scholar 

  16. Liao Y, Bang D, Cosgrove S, Dulin R, Harris Z, Taylor A, et al. Surveillance of health status in minority communities - racial and ethnic approaches to community health across the U.S. (REACH U.S.) risk factor survey, United States, 2009. MMWR Surveill Summ. 2011;60(6):1–44.

    PubMed  Google Scholar 

  17. Bibbins-Domingo K, Pletcher MJ, Lin F, Vittinghoff E, Gardin JM, Arynchyn A, et al. Racial differences in incident heart failure among young adults. N Engl J Med. 2009;360(12):1179–90. doi:10.1056/NEJMoa0807265.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Howard G, Lackland DT, Kleindorfer DO, Kissela BM, Moy CS, Judd SE, et al. Racial differences in the impact of elevated systolic blood pressure on stroke risk. JAMA Intern Med. 2013;173(1):46–51. doi:10.1001/2013.jamainternmed.857.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Yancy CW. Heart failure in blacks: etiologic and epidemiologic differences. Curr Cardiol Rep. 2001;3(3):191–7.

    Article  CAS  PubMed  Google Scholar 

  20. Bahrami H, Kronmal R, Bluemke DA, Olson J, Shea S, Liu K, et al. Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. Arch Intern Med. 2008;168(19):2138–45. doi:10.1001/archinte.168.19.2138.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. Natl Vital Stat Rep. 2013;61(4):1–117.

    PubMed  Google Scholar 

  22. Graham G. Population-based approaches to understanding disparities in cardiovascular disease risk in the United States. Int J Gen Med. 2014;7:393–400. doi:10.2147/IJGM.S65528. This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the US. Disparities in risk burden, as well as inequity in healthcare and health outcomes are described in depth.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fiscella K, Holt K. Racial disparity in hypertension control: tallying the death toll. Ann Fam Med. 2008;6(6):497–502. doi:10.1370/afm.873.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347(20):1585–92. doi:10.1056/NEJMsa012979.

    Article  PubMed  Google Scholar 

  25. Shaw EK, Howard J, Clark EC, Etz RS, Arya R, Tallia AF. Decision-making processes of patients who use the emergency department for primary care needs. J Health Care Poor Underserved. 2013;24(3):1288–305. doi:10.1353/hpu.2013.0140.

    Article  PubMed  Google Scholar 

  26. Mathison DJ, Chamberlain JM, Cowan NM, Engstrom RN, Fu LY, Shoo A, et al. Primary care spatial density and nonurgent emergency department utilization: a new methodology for evaluating access to care. Acad Pediatr. 2013;13(3):278–85. doi:10.1016/j.acap.2013.02.006.

    Article  PubMed  Google Scholar 

  27. Naderi S, Barnett B, Hoffman RS, Dalipi R, Houdek L, Alagappan K, et al. Factors associated with failure to follow-up at a medical clinic after an ED visit. Am J Emerg Med. 2012;30(2):347–51. doi:10.1016/j.ajem.2010.11.034.

    Article  PubMed  Google Scholar 

  28. Blanchard J, Ogle K, Thomas O, Lung D, Asplin B, Lurie N. Access to appointments based on insurance status in Washington, D.C. J Health Care Poor Underserved. 2008;19(3):687–96. doi:10.1353/hpu.0.0036.

    Article  PubMed  Google Scholar 

  29. Cheung PT, Wiler JL, Lowe RA, Ginde AA. National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries. Ann Emerg Med. 2012;60(1):4–10.e2. doi:10.1016/j.annemergmed.2012.01.035.

    Article  PubMed  Google Scholar 

  30. Wexler R, Hefner JL, Sieck C, Taylor CA, Lehman J, Panchal AR, et al. Connecting emergency department patients to primary care. J Am Board Fam Med. 2015;28(6):722–32. doi:10.3122/jabfm.2015.06.150044.

    Article  PubMed  Google Scholar 

  31. Block L, Ma S, Emerson M, Langley A, Torre Dde L, Noronha G. Does access to comprehensive outpatient care alter patterns of emergency department utilization among uninsured patients in East Baltimore? J Prim Care Community Health. 2013;4(2):143–7. doi:10.1177/2150131913477116.

    Article  PubMed  Google Scholar 

  32. Kirby JB, Kaneda T. Neighborhood socioeconomic disadvantage and access to health care. J Health Soc Behav. 2005;46(1):15–31.

    Article  PubMed  Google Scholar 

  33. Blumenthal D, Mort E, Edwards J. The efficacy of primary care for vulnerable population groups. Health Serv Res. 1995;30(1 Pt 2):253–73.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Diamant AL, Hays RD, Morales LS, Ford W, Calmes D, Asch S, et al. Delays and unmet need for health care among adult primary care patients in a restructured urban public health system. Am J Public Health. 2004;94(5):783–9.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R. Trends and characteristics of US emergency department visits, 1997–2007. JAMA. 2010;304(6):664–70. doi:10.1001/jama.2010.1112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Garcia TC, Bernstein AB, Bush MA. Emergency department visitors and visits: who used the emergency room in 2007? NCHS Data Brief. 2010;38:1–8.

    PubMed  Google Scholar 

  37. Oetjen RM, Oetjen DM, Rotarius T, Liberman A. Emergency department utilization by insured users: a study of motivating factors. Health Care Manag (Frederick). 2010;29(3):199–212. doi:10.1097/HCM.0b013e3181e8e077.

    Google Scholar 

  38. Oster A, Bindman AB. Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations. Med Care. 2003;41(2):198–207. doi:10.1097/01.MLR.0000045021.70297.9F.

    PubMed  Google Scholar 

  39. Parikh PB, Yang J, Leigh S, Dorjee K, Parikh R, Sakellarios N, et al. The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease. J Gen Intern Med. 2014;29(1):76–81. doi:10.1007/s11606-013-2635-6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Weber EJ, Showstack JA, Hunt KA, Colby DC, Callaham ML. Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Ann Emerg Med. 2005;45(1):4–12. doi:10.1016/j.annemergmed.2004.06.023.

    Article  PubMed  Google Scholar 

  41. Taubman SL, Allen HL, Wright BJ, Baicker K, Finkelstein AN. Medicaid increases emergency-department use: evidence from Oregon’s health insurance experiment. Science. 2014;343(6168):263–8. doi:10.1126/science.1246183.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Bernstein SL, D’Onofrio G. Public health in the emergency department: academic emergency medicine consensus conference executive summary. Acad Emerg Med. 2009;16(11):1037–9. doi:10.1111/j.1553-2712.2009.00548.x.

    Article  PubMed  Google Scholar 

  43. Brody A, Murphy E, Flack J, Levy P. Primary care in the emergency department—an untapped resource for public health research and innovation. West Indian Med J. 2014;63 Suppl 3.

  44. Honigman LS, Wiler JL, Rooks S, Ginde AA. National study of non-urgent emergency department visits and associated resource utilization. West J Emerg Med. 2013;14(6):609–16. doi:10.5811/westjem.2013.5.16112.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Janke AT, Brody AM, Overbeek DL, Bedford JC, Welch RD, Levy PD. Access to care issues and the role of EDs in the wake of the affordable care act. Am J Emerg Med. 2015;33(2):181–5. doi:10.1016/j.ajem.2014.11.006.

    Article  PubMed  Google Scholar 

  46. Gandhi SO, Grant LP, Sabik LM. Trends in nonemergent use of emergency departments by health insurance status. Med Care Res Rev. 2014;71(5):496–521. doi:10.1177/1077558714541481.

    Article  PubMed  Google Scholar 

  47. Hsia RY, Brownell J, Wilson S, Gordon N, Baker LC. Trends in adult emergency department visits in California by insurance status, 2005–2010. JAMA. 2013;310(11):1181–3. doi:10.1001/jama.2013.228331.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Pitts SA, Corliss HL, Kharasch SJ, Gordon CM. Advance provision of emergency contraception in an urban pediatric emergency department. J Pediatr Adolesc Gynecol. 2011;24(6):392–6. doi:10.1016/j.jpag.2011.05.012.

    Article  PubMed  Google Scholar 

  49. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation. 2015. doi:10.1161/CIR.0000000000000350.

    Google Scholar 

  50. Parikh PB, Yang J, Leigh S, Dorjee K, Parikh R, Sakellarios N, et al. The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease. J Gen Intern Med. 2013. doi:10.1007/s11606-013-2635-6.

    Google Scholar 

  51. Delgado MK, Acosta CD, Ginde AA, Wang NE, Strehlow MC, Khandwala YS, et al. National survey of preventive health services in US emergency departments. Ann Emerg Med. 2011;57(2):104–8.e2. doi:10.1016/j.annemergmed.2010.07.015.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Baumann BM, Cline DM, Pimenta E. Treatment of hypertension in the emergency department. J Am Soc Hypertens. vol 5. United States: 2011 American Society of Hypertension. Published by Elsevier Inc; 2011. p. 366–77.

  53. Tanabe P, Persell SD, Adams JG, McCormick JC, Martinovich Z, Baker DW. Increased blood pressure in the emergency department: pain, anxiety, or undiagnosed hypertension? Ann Emerg Med. 2008;51(3):221–9. doi:10.1016/j.annemergmed.2007.10.017.

    Article  PubMed  Google Scholar 

  54. Karras DJ, Ufberg JW, Heilpern KL, Cienki JJ, Chiang WK, Wald MM, et al. Elevated blood pressure in urban emergency department patients. Acad Emerg Med. 2005;12(9):835–43. doi:10.1197/j.aem.2005.04.015.

    Article  PubMed  Google Scholar 

  55. Baumann BM, Abate NL, Cowan RM, Boudreaux ED. Differing prevalence estimates of elevated blood pressure in ED patients using 4 methods of categorization. Am J Emerg Med. 2008;26(5):561–5. doi:10.1016/j.ajem.2007.09.001.

    Article  PubMed  Google Scholar 

  56. Niska RW. Blood pressure measurements at emergency department visits by adults: United States, 2007–2008. NCHS Data Brief. 2011;72:1–8.

    PubMed  Google Scholar 

  57. Adhikari S, Mathiasen R. Epidemiology of elevated blood pressure in the ED. Am J Emerg Med. 2014;32(11):1370–2. doi:10.1016/j.ajem.2014.08.034.

    Article  PubMed  Google Scholar 

  58. McNaughton CD, Self WH, Zhu Y, Janke AT, Storrow AB, Levy P. Incidence of hypertension-related emergency department visits in the United States, 2006 to 2012. Am J Cardiol. 2015;116(11):1717–23. doi:10.1016/j.amjcard.2015.09.007.

    Article  PubMed  Google Scholar 

  59. Pinna G, Pascale C, Fornengo P, Arras S, Piras C, Panzarasa P, et al. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study. PLoS ONE. 2014;9(4):e93542. doi:10.1371/journal.pone.0093542.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Levy P, Ye H, Compton S, Zalenski R, Byrnes T, Flack JM, et al. Subclinical hypertensive heart disease in black patients with elevated blood pressure in an inner-city emergency department. Ann Emerg Med. 2012;60(4):467–74. doi:10.1016/j.annemergmed.2012.03.030.

    Article  PubMed  Google Scholar 

  61. Levy PD, Cline D. Asymptomatic hypertension in the emergency department: a matter of critical public health importance. Acad Emerg Med. 2009;16(11):1251–7. doi:10.1111/j.1553-2712.2009.00512.x.

    Article  PubMed  Google Scholar 

  62. Levy P, Shelby A, Davidson R, Mahn J, Marinica A, Carroll J, et al. Acute blood pressure reduction and outcomes in asymptomatic hypertension: a retrospective cohort study. Ann Emerg Med. 2011;58(4):S238–9.

    Article  Google Scholar 

  63. Decker WW, Godwin SA, Hess EP, Lenamond CC, Jagoda AS. Clinical policy: critical issues in the evaluation and management of adult patients with asymptomatic hypertension in the emergency department. Ann Emerg Med. 2006;47(3):237–49. doi:10.1016/j.annemergmed.2005.10.003.

    Article  PubMed  Google Scholar 

  64. Wolf SJ, Lo B, Shih RD, Smith MD, Fesmire FM. Clinical policy: critical issues in the evaluation and management of adult patients in the emergency department with asymptomatic elevated blood pressure. Ann Emerg Med. 2013;62(1):59–68. doi:10.1016/j.annemergmed.2013.05.012. An evidence based update to the 2006 ACEP clinical policy on the same topic. Two issues regarding asymptomatic HTN are addressed: 1) In ED patients with asymptomatic elevated blood pressure, does screening for target organ injury reduce rates of adverse outcomes? 2) In patients with asymptomatic markedly elevated blood pressure, does ED medical intervention reduce rates of adverse outcomes?.

    Article  PubMed  Google Scholar 

  65. Baumann BM, Cienki JJ, Cline DM, Egging D, Lehrmann JF, Tanabe P. Evaluation, management, and referral of elderly emergency department patients with elevated blood pressure. Blood Press Monit. 2009;14(6):251–6. doi:10.1097/MBP.0b013e328332fd40.

    Article  PubMed  Google Scholar 

  66. Baumann BM, Cline DM, Cienki JJ, Egging D, Lehrmann JF, Tanabe P. Provider self-report and practice: reassessment and referral of emergency department patients with elevated blood pressure. Am J Hypertens. 2009;22(6):604–10. doi:10.1038/ajh.2009.44.

    Article  PubMed  Google Scholar 

  67. Lehrmann JF, Tanabe P, Baumann BM, Jones MK, Martinovich Z, Adams JG. Knowledge translation of the American College of Emergency Physicians clinical policy on hypertension. Acad Emerg Med. 2007;14(11):1090–6. doi:10.1197/j.aem.2007.05.016.

    Article  PubMed  Google Scholar 

  68. Adhikari S, Mathiasen R, Lander L. Elevated blood pressure in the emergency department: lack of adherence to clinical practice guidelines. Blood Press Monit. 2015. doi:10.1097/mbp.0000000000000158.

    Google Scholar 

  69. Levy PD, Mahn JJ, Miller J, Shelby A, Brody A, Davidson R, et al. Blood pressure treatment and outcomes in hypertensive patients without acute target organ damage: a retrospective cohort. Am J Emerg Med. 2015. doi:10.1016/j.ajem.2015.05.036.

    PubMed Central  Google Scholar 

  70. Brody A, Rahman T, Reed B, Millis S, Ference B, Flack JM, et al. Safety and efficacy of antihypertensive prescription at emergency department discharge. Acad Emerg Med. 2015;22(5):632–5. doi:10.1111/acem.12660. A retrospective study which demonstrates short term efficacy and lack of adverse events associated ED prescription of antihypertensive medications. This can be considered hypothesis generating in support of the concept that ED physicians can initiate and titrate long-term BP control therapies.

    Article  PubMed  Google Scholar 

  71. Cho DD, Austin PC, Atzema CL. Management of discharged emergency department patients with a primary diagnosis of hypertension: a multicentre study. CJEM. 2015;17(5):523–31. doi:10.1017/cem.2015.36.

    Article  PubMed  Google Scholar 

  72. Brody A, Reed B, Janke A, Goldberg E, McNaughton C, Levy P. Survey of emergency physician approaches to management of asymptomatic hypertension. Acad Emerg Med. 2015;22(S1):S308–9.

    Google Scholar 

  73. Tanabe P, Cline DM, Cienki JJ, Egging D, Lehrmann JF, Baumann BM. Barriers to screening and intervention for ED patients at risk for undiagnosed or uncontrolled hypertension. J Emerg Nurs. 2011;37(1):17–23. doi:10.1016/j.jen.2009.11.017.

    Article  PubMed  Google Scholar 

  74. Brody A, Reed B, Goldberg E, McNaughton C, Levy P. Barriers to emergency physician diagnosis and treatment of asymptomatic hypertension. Acad Emerg Med. 2015;22(S1):S398–9.

    Google Scholar 

  75. Souffront K, Chyun D, Kovner C. Barriers to referral for elevated blood pressure in the emergency department and differences between provider type. J Clin Hypertens (Greenwich). 2015;17(3):207–14. doi:10.1111/jch.12468. This article describes a multidisciplinary sample of ED providers across the United States (n = 450) who were surveyed to identify barriers to referral for elevated blood pressure (BP) in the ED, and differences between provider types (MD, RN, PA). Overall referral rates were low (most provider referred patients only ‘sometimes’, or ‘rarely’). Knowledge deficits, time constraints, and lack of financial compensation were identified as common barriers.

    Article  Google Scholar 

  76. Richardson LD, Babcock Irvin C, Tamayo-Sarver JH. Racial and ethnic disparities in the clinical practice of emergency medicine. Acad Emerg Med. 2003;10(11):1184–8.

    Article  PubMed  Google Scholar 

  77. Rand CS, Butz AM, Kolodner K, Huss K, Eggleston P, Malveaux F. Emergency department visits by urban African American children with asthma. J Allergy Clin Immunol. 2000;105(1 Pt 1):83–90.

    Article  CAS  PubMed  Google Scholar 

  78. Bhattacharya P, Mada F, Salowich-Palm L, Hinton S, Millis S, Watson SR, et al. Are racial disparities in stroke care still prevalent in certified stroke centers? J Stroke Cerebrovasc Dis. 2013;22(4):383–8. doi:10.1016/j.jstrokecerebrovasdis.2011.09.018.

    Article  PubMed  Google Scholar 

  79. Singh JA, Lu X, Ibrahim S, Cram P. Trends in and disparities for acute myocardial infarction: an analysis of Medicare claims data from 1992 to 2010. BMC Med. 2014;12(1):190. doi:10.1186/s12916-014-0190-6.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Mills AM, Shofer FS, Boulis AK, Holena DN, Abbuhl SB. Racial disparity in analgesic treatment for ED patients with abdominal or back pain. Am J Emerg Med. 2011;29(7):752–6. doi:10.1016/j.ajem.2010.02.023.

    Article  PubMed  Google Scholar 

  81. Ezenkwele UA, Roodsari GS. Cultural competencies in emergency medicine: caring for Muslim-American patients from the Middle East. J Emerg Med. 2013;45(2):168–74. doi:10.1016/j.jemermed.2012.11.077.

    Article  PubMed  Google Scholar 

  82. Bowman SH, Moreno-Walton L, Ezenkwele UA, Heron SL. Diversity in emergency medicine education: expanding the horizon. Acad Emerg Med. 2011;18 Suppl 2:S104–9. doi:10.1111/j.1553-2712.2011.01184.x.

    Article  PubMed  Google Scholar 

  83. Cultural awareness and emergency care. Ann Emerg Med. 2008;52(2):189. doi:10.1016/j.annemergmed.2008.05.028.

  84. Salami O, Salvador J, Vega R. Reasons for nonurgent pediatric emergency department visits: perceptions of health care providers and caregivers. Pediatr Emerg Care. 2012;28(1):43–6. doi:10.1097/PEC.0b013e31823f2412.

    Article  PubMed  Google Scholar 

  85. Guttman N, Nelson MS, Zimmerman DR. When the visit to the emergency department is medically nonurgent: provider ideologies and patient advice. Qual Health Res. 2001;11(2):161–78.

    Article  CAS  PubMed  Google Scholar 

  86. Durand AC, Gentile S, Devictor B, Palazzolo S, Vignally P, Gerbeaux P, et al. ED patients: how nonurgent are they? Systematic review of the emergency medicine literature. Am J Emerg Med. 2011;29(3):333–45. doi:10.1016/j.ajem.2010.01.003.

    Article  PubMed  Google Scholar 

  87. Greer TM, Brondolo E, Brown P. Systemic racism moderates effects of provider racial biases on adherence to hypertension treatment for African Americans. Health Psychol. 2014;33(1):35–42. doi:10.1037/a0032777.

    Article  PubMed  Google Scholar 

  88. Schilling Jones S. Medicare final rule changes 2015 PQRS requirements. ACEPNow. 2015 February 11.

  89. D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44. doi:10.1001/jama.2015.3474.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Atzema CL, Austin PC, Chong AS, Dorian P, Jackevicius CA. The long-term use of warfarin among atrial fibrillation patients discharged from an emergency department with a warfarin prescription. Ann Emerg Med. 2015;66(4):347–54.e2. doi:10.1016/j.annemergmed.2015.03.024.

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr. Phillip Levy is currently funded by the National Institute on Minority Health and Health Disparities (PI: Levy-MD 5 R01 MD005849-05).

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Authors and Affiliations

  1. Department of Emergency Medicine, School of Medicine, Wayne State University, 4201 St. Antoine, Detroit, MI, USA

    Aaron Brody, Alex Janke, Vineet Sharma & Phillip Levy

  2. Clinical Research Service Center, School of Medicine, Wayne State University, Detroit, MI, USA

    Aaron Brody & Phillip Levy

  3. Integrative Biosciences Center (iBio), Wayne State University, 6135 Woodward Ave., Detroit, MI, 48202, USA

    Aaron Brody & Phillip Levy

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  2. Alex Janke
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  3. Vineet Sharma
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  4. Phillip Levy
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Correspondence to Aaron Brody.

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Drs. Brody, Janke, Sharma, and Levy declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Hypertension and Emergency Medicine

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Brody, A., Janke, A., Sharma, V. et al. Public Health, Hypertension, and the Emergency Department. Curr Hypertens Rep 18, 50 (2016). https://doi.org/10.1007/s11906-016-0654-5

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  • DOI: https://doi.org/10.1007/s11906-016-0654-5

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