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Home Research Research Library Diuretic of Choice in ABFM Hypertension Self-Assessment Module Simulations Diuretic of Choice in ABFM Hypertension Self-Assessment Module Simulations 2012 Author(s) Hagen, Michael D, Sumner, W, and Fu, H Topic(s) Education & Training Keyword(s) Clinical Simulation Volume Journal of the American Board of Family Medicine Source Journal of the American Board of Family Medicine BACKGROUND: Evidence suggests that chlorthalidone has therapeutic advantages over hydrochlorothiazide, perhaps because of a longer antihypertensive effect. Although guidelines such as the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure treat diuretics as a class, some experts believe chlorthalidone is the diuretic of choice in hypertension management. We evaluated diplomates’ use of chlorthalidone and hydrochlorothiazide as first-choice diuretics in virtual patient simulations of hypertension in the American Board of Family Medicine Maintenance of Certification for Family Physicians self-assessment modules. METHODS: We examined action logs for hypertension simulations completed between 2004 and 2011 and identified initial antihypertensive choices made by diplomates. We tabulated uses of any diuretic as initial treatment, distinguishing between chlorthalidone, hydrochlorothiazide, and other diuretic choices. We examined trends in the use of diuretics and chlorthalidone in simulations using linear models. RESULTS: Chlorthalidone use increased 0.7 percentage points per year (test for beta >0, P < .0013), from approximately 1.3% of simulation prescriptions in 2004 to about 4.8% in 2010 and 2011, whereas hydrochlorothiazide prescriptions fell 2 percentage points per year (P = .035), from nearly 57% to 47%. As a fraction of all diuretic use, chlorthalidone increased 1.4 percentage points per year (P = .0006), from 2% to 9%. CONCLUSIONS: Small but growing numbers of diplomates are heeding recommendations in the growing literature to start with chlorthalidone rather than hydrochlorothiazide, at least in the virtual patient environment. Observed choices in virtual patient management strongly imply that this is a valid topic for additional attention in the hypertension self-assessment module. Read More ABFM Research Read all 2019 Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis Go to Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis 2018 Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go Go to Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go 2015 Transforming Training to Build the Family Physician Workforce Our Country Needs Go to Transforming Training to Build the Family Physician Workforce Our Country Needs 2002 The National Institute for Program Director Development: a school for program directors Go to The National Institute for Program Director Development: a school for program directors
Author(s) Hagen, Michael D, Sumner, W, and Fu, H Topic(s) Education & Training Keyword(s) Clinical Simulation Volume Journal of the American Board of Family Medicine Source Journal of the American Board of Family Medicine
ABFM Research Read all 2019 Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis Go to Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis 2018 Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go Go to Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go 2015 Transforming Training to Build the Family Physician Workforce Our Country Needs Go to Transforming Training to Build the Family Physician Workforce Our Country Needs 2002 The National Institute for Program Director Development: a school for program directors Go to The National Institute for Program Director Development: a school for program directors
2019 Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis Go to Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis
2018 Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go Go to Preparing the Personal Physician for Practice: What We’ve Learned and Where We Need to Go
2015 Transforming Training to Build the Family Physician Workforce Our Country Needs Go to Transforming Training to Build the Family Physician Workforce Our Country Needs
2002 The National Institute for Program Director Development: a school for program directors Go to The National Institute for Program Director Development: a school for program directors