The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.

 

The 2021 AANP conference provided a plethora of presentations on issues and concerns among patients most likely to present in the primary care setting. As Clinical Advisor’s roving reporter, the following are my picks of the top 5 most practical presentations from the conference, which cover topics ranging from obesity medications and suicide prevention to managing hypertension in diverse populations, cannabinoid use, and bipolar disorder management.

Antiobesity Medications

The prevalence of obesity has risen by 12% in 18 years.1 In fact, obesity is seen as such an important risk factor to manage that we often include BMI as a vital sign during office visits. Differentiating between obesity and morbid obesity is essential in stratifying risk accordingly.  


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Although obesity is a chronic, progressive, relapsing disease, it is treatable, as described in Sandra Christensen, MSN, ARNP, FNP-BC, FOMA, in the session Anti-obesity Medications: How They Work & How to Use Them. As we consider the expansive problem of obesity, we see that it affects every level of care. Pharmacotherapy is one of the 4 pillars of comprehensive obesity treatment and may increase adherence to the other 3 pillars of nutritional therapy, physical activity, and behavior modification. When skillfully prescribed, antiobesity medications can be used safely and effectively. In this review, Dr Christensen guides clinicians on strategies to provide individualized obesity care in daily practice. The best aspect of this presentation is the focus on relevant, practical case studies that can be implemented in day-to-day practice to improve quality of life for patients.

The Suicidal Brain

Mental health challenges and opportunities to care for our patients continue to grow, particularly in light of the mental health risk imposed by COVID-19 through social isolation and illness. The impact of the COVID-19 pandemic will continue to rise during this postpandemic era, especially among the most vulnerable populations.2  

With this important topic in mind, Teena M. McGuinness, PhD, PMHNP-BC, FAANP, FAAN, discussed the pathways within the limbic region of the brain linked to suicidal ideation in the session Prevention of Suicide by Understanding the Suicidal Brain. Further, the role of traumatic brain injuries (acute or repeated) in the risk for suicide was explored. Additionally, the expert delineated important concepts from the Center for Disease Control and Prevention’s Adverse Childhood Experiences (ACEs) Prevention Strategy Plan and related them to increased risk for suicide. Knowledge of your patients’ ACEs score (with items focusing on adversities such as divorce, abuse, poverty, and parent history of mental illness and incarceration) helps to predict adult health outcomes such as cardiovascular disease, diabetes, and cancer. ACEs scores also are associated with higher suicide rates and poorer mental health outcomes. Pharmacological agents for suicide prevention are reviewed by Dr McGuinness as well. This is a can’t miss presentation for NPs in practice everywhere. Awareness of the increased risk factors presented by COVID-19 is essential in our screening of patients for suicide, regardless of the reason for the clinical encounter.

Hypertension in Diverse Populations

The incidence of hypertension is nearly 62.6% among patients older than 60 years and frequently is treated in the primary care setting.3 Understanding how to manage this condition effectively and in a timely fashion will affect health outcomes, especially as we appreciate the impact of cultural diversity on management and patient perspective of this chronic condition. In the session Hypertension in Diverse Populations, Irene W. Bean, DNP, APRN, PMHNP, FAANP, provided an overview of how to address the needs of our patients from multicultural backgrounds, given the significant differences in blood pressure prevalence and control rates based on race/ethnicity. Although the prevalence of hypertension is higher in select ethnic/racial groups (eg, non-Hispanic Black patients), significant disparities in hypertension control and hypertension-related morbidity and mortality also exist. Persistent differences in hypertension, chronic kidney disease, and associated cardiovascular disease are noted among racial/ethnic minority groups. The causes of the inequalities are multifactorial and include social determinants of health such as insurance coverage, poor access to health care, and illiteracy. Additional gaps exist in the affordability of antihypertensive therapies and nutritional intake. This is an essential presentation to attend as hypertension continues to be one of the most common chronic diseases for our patients.

Cannabinoid Use and Abuse

In the session Cannabinoid Use and Abuse: A Primer for Clinicians, Melissa Kalensky, DNP, FNP-BC, CNE, reviewed the importance of understanding cannabinoid use in everyday practice. Cannabis is one of the most widely used recreational drugs, with reports of increased use across all age groups over the last decade. Cannabinoids are currently legal for medical use in 36 states and 4 territories and recreational use in 18 states plus 3 territories to date, making use increasingly common. Nurse practitioners (NPs) need to understand the clinical considerations associated with both acute intoxication and chronic cannabinoid use. Dr Kalensky provided an evidence-based approach to examining the pharmacologic principles related to cannabinoid use, its physiologic and psychological effects, as well as the DSM-5 criteria for diagnosis of cannabis use disorder. Considerations regarding potential adverse and therapeutic effects were examined, including issues related to potential efficacy, safety, and prescription drug interactions.

Individualized Treatment of Bipolar Disorder

In Achieving Balance: Personalized Treatment of Bipolar Disorder, Josh Hamilton, DNP, RN, PMH-BC, FNP-C, PMHNP-BC, CNE, CTMH, FAANP, provided a comprehensive review of this important condition and treatment options available for clinicians in primary or specialty practice. Bipolar disorder often is misdiagnosed as symptoms can mimic those of generalized anxiety disorder or major depressive disorder. It is essential to recognize the unique features of bipolar disorder to maximize timely and efficient diagnosis of this disorder.

Dr Hamilton highlighted how to integrate diagnostic criteria into the case identification, diagnosis, and treatment of bipolar disorder. He also reviewed updated disease models and diagnostic criteria for bipolar spectrum disorders. Bipolar affective pathophysiology is redefined in the context of epigenetics and neurobiology, with specific attention to contemporary pharmacological approaches to manage bipolar disorders. Practical applications for NPs are presented.

In conclusion, the presentations at AANP 2021 are practical and relevant to everyday practice for NPs. Beyond these exciting presentation features, there are poster presentations you will not want to miss covering everything from dermatologic simulations in NP education to rural health care delivery. We hope these tips are helpful to you as you seek to take full advantage of important clinical pearls presented at the 2021 AANP conference.

Visit Clinical Advisor’s meetings section for complete coverage of AANP 2021. All conference sessions are available to registered attendees through August 31, 2021.

Kristene Diggins, DNP, MBA, FAANP, CNE, NEA-BC, DCC, is a doctorate-prepared NP with 15 years of experience as a family NP, in both primary and geriatric care. In addition, Dr Diggins is certified as nurse educator and administrator. She served as the National Manager of Professional Practice for 4 years with Minuteclinic, supporting nurse practitioners in their career development. Dr Diggins works as adjunct faculty for University of Phoenix as well as Chamberlain University and Liberty University. Dr Diggins and her husband live in Charlotte, NC

References

1. Centers for Disease Control and Prevention. Adult obesity facts. Updated June 7, 2021. Accessed July 2, 2021.  Retrieved on June 24, 2021. https://www.cdc.gov/obesity/data/adult.html

2. Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM. 2020;113(10):707-712.

3. Centers for Disease Control and Prevention. Hypertension prevalence and control among adults: united states, 2015–2016. Updated October 18, 2017. Accessed July 2, 2021.  Retrieved on June 24, https://www.cdc.gov/nchs/products/databriefs/db289.htm