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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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Khan N, Bell A, Berg A, Campbell N, Kaczorowski J, Rabi D, Schiffrin EL, Tsuyuki RT. A call to action to implement prescribing authority to pharmacists for hypertension management. Can Pharm J (Ott) 2019; 152:285-287. [PMID: 31534583 DOI: 10.1177/1715163519866144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Patient preferences for management of high blood pressure in the UK: a discrete choice experiment. Br J Gen Pract 2019; 69:e629-e637. [PMID: 31405832 PMCID: PMC6692085 DOI: 10.3399/bjgp19x705101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Background With a variety of potentially effective hypertension management options, it is important to determine how patients value different models of care, and the relative importance of factors in their decision-making process. Aim To explore patient preferences for the management of hypertension in the UK. Design and setting Online survey of patients who have hypertension in the UK including an unlabelled discrete choice experiment (DCE). Method A DCE was developed to assess patient preferences for the management of hypertension based on four attributes: model of care, frequency of blood pressure (BP) measurement, reduction in 5-year cardiovascular risk, and costs to the NHS. A mixed logit model was used to estimate preferences, willingness-to-pay was modelled, and a scenario analysis was conducted to evaluate the impact of changes in attribute levels on the uptake of different models of care. Results One hundred and sixty-seven participants completed the DCE (aged 61.4 years, 45.0% female, 82.0% >5 years since diagnosis). All four attributes were significant in choice (P<0.05). Reduction in 5-year cardiovascular risk was the main driver of patient preference as evidenced in the scenario and willingness-to-pay analyses. GP management was significantly preferred over self-management. Patients preferred scenarios with more frequent BP measurement, and lower costs to the NHS. Conclusion Participants had similar preferences for GP management, pharmacist management, and telehealth, but a negative preference for self-management. When introducing new models of care for hypertension to patients, discussion of the potential benefits in terms of risk reduction should be prioritised to maximise uptake.
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Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, Egan BM, Flack JM, Gidding SS, Judd E, Lackland DT, Laffer CL, Newton-Cheh C, Smith SM, Taler SJ, Textor SC, Turan TN, White WB. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension 2019; 72:e53-e90. [PMID: 30354828 DOI: 10.1161/hyp.0000000000000084] [Citation(s) in RCA: 556] [Impact Index Per Article: 111.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the "white-coat effect" (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
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Smith GD. Tai Chi: a promising adjunct nursing intervention to reduce risks of cardiovascular disease and improve psychosocial well-being in adults with hypertension. Evid Based Nurs 2019; 22:45. [PMID: 30591522 DOI: 10.1136/ebnurs-2018-103007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Graeme D Smith
- Professor of Nursing, Caritas Institute of Higher Education, Hong Kong, SAR, China
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Ödesjö H, Adamsson Eryd S, Franzén S, Hjerpe P, Manhem K, Rosengren A, Thorn J, Björck S. Visit patterns at primary care centres and individual blood pressure level - a cross-sectional study. Scand J Prim Health Care 2019; 37:53-59. [PMID: 30821170 PMCID: PMC6452911 DOI: 10.1080/02813432.2019.1569369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control. DESIGN AND SETTING Cross-sectional register-based study on all patients with hypertension who visited 188 PHCCs in a Swedish region. PATIENTS A total of 88,945 patients with uncomplicated hypertension age 40-79. MAIN OUTCOME MEASURES Odds ratio (OR) for the individual patient to achieve the BP target of ≤140/90 mmHg. RESULTS Overall, 63% of patients had BP ≤ 140/90 mmHg (48% BP < 140/90). The PHCC that the patient was enrolled at and, as part of that, more nurse visits at PHCC level was associated with BP control, adjusted OR 1,10 (95% CI 1.01 to 1.21). Patients visiting PHCCs with the highest proportion of visits with nurses had an even higher chance of achieving the BP target, OR 1.19 (95% CI 1.07 to 1.32). CONCLUSIONS In a Swedish population of patients with hypertension, about half do not achieve recommended treatment goals. Organisation of PHCC and team care are known as factors influencing BP control. Our results suggests that a larger focus on PHCC organisation including nurse based care could improve hypertension care.
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Affiliation(s)
- H. Ödesjö
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE405 30, Sweden;
- Primary Health Care, Region Västra Götaland, Närhälsan Torslanda Vårdcentral, Torslanda, SE-423 34, Sweden;
- CONTACT Helena Ödesjö Physician, Primary Health Care, Region Västra Götaland, Närhälsan Torslanda Vårdcentral, Nordhagsvägen 2A, SE-423 34Torslanda, Sweden
| | - S. Adamsson Eryd
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Östra Hospital, Gothenburg, SE 416 50, Sweden;
| | - S. Franzén
- Centre of Registers Västra Götaland, Gothenburg, SE 413 45, Sweden;
| | - P. Hjerpe
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE405 30, Sweden;
- R&D Centre Skaraborg Primary Care, Skövde, Skövde, SE 541 30, Sweden
| | - K. Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Östra Hospital, Gothenburg, SE 416 50, Sweden;
| | - A. Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Östra Hospital, Gothenburg, SE 416 50, Sweden;
| | - J. Thorn
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE405 30, Sweden;
| | - S. Björck
- Centre of Registers Västra Götaland, Gothenburg, SE 413 45, Sweden;
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Kassavou A, Houghton V, Edwards S, Brimicombe J, Wilson E, Griffin S, Sutton S. Acceptability of the Medication Adherence for Patients Support intervention to improve adherence to patients prescribed medications for hypertension or comorbidities, as an adjunct to primary care: A qualitative study. J Health Psychol 2018; 26:168-180. [PMID: 30565485 DOI: 10.1177/1359105318819051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Tailored interventions delivered via text and voice messages can improve adherence to multiple medications. However, no such intervention has been developed in the UK primary-care setting. We conducted focus groups with 12 patients with hypertension, type 2 diabetes, or both conditions, presumed to be non-adherent and recruited from deprived neighborhoods, to assess the acceptability and inform the development of an intervention to provide ongoing support for adherence, as an adjunct to primary-care consultations. Patients recommended ways to improve the tailored content and delivery of the intervention; like highly interactive messages to report both medication taking and determinants of medication adherence.
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1780] [Impact Index Per Article: 296.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5550] [Impact Index Per Article: 925.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. ACTA ACUST UNITED AC 2018; 12:579.e1-579.e73. [DOI: 10.1016/j.jash.2018.06.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Jeong S, Choi H, Gwon SH, Kim J. Telephone Support and Telemonitoring for Low-Income Older Adults. Res Gerontol Nurs 2018; 11:198-206. [PMID: 29767806 DOI: 10.3928/19404921-20180502-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 03/06/2018] [Indexed: 11/20/2022]
Abstract
The objective of the current pilot study was to determine whether nurse-led telephone counseling improves health behavior, self-care, and physiological indices for low-income older adults using a telemonitoring system. The control group (n = 15) was provided with weekly health education only, and the intervention group (n = 20) was given additional telephone support by nurses. At baseline and 8 weeks, data on health and self-care behaviors were collected using a self-reported questionnaire, and blood pressure and fasting blood glucose levels were assessed. Nurse-led telephone support had a medium effect on improving health behavior (Cohen's d = 0.58, 95% confidence interval [CI] [-0.10, 1.27]), reducing systolic blood pressure (Cohen's d = -0.61, 95% CI [-1.29, 0.08]), and improving self-care behavior for hypertension (Cohen's d = 1.16, 95% CI [0.05, 2.27]). Findings support that nurse-led telephone support may be effective for improvements in health behavior, systolic blood pressure, and hypertension self-care in disadvantaged older adults under remote monitoring. Further studies are needed to obtain a powered sample size and investigate the long-term effects of personalized elements surrounding telehealth in community-based settings. [Res Gerontol Nurs. 2018; 11(4):198-206.].
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Cardiovascular disease accounts for 17,500 deaths globally, representing nearly half of all non-communicable disease deaths. The World Health Organization has set nine lifestyle, risk factor and medicines targets to achieve by 2025 with the aim of reducing premature mortality from non-communicable diseases by 25%. In order to succeed in this, we need to equip our global health professional workforce with the skills to support patients and their families with making lifestyle changes and being in concordance with cardioprotective medication regimes at every opportunity. Success depends on collegiate working through effective interdisciplinary team-based care characterised by shared goals, clear roles, mutual trust, effective communication and measurable processes and outcomes, with the patient and family at the centre of care. Nurses are the largest sector of the health professional workforce and their role in prevention should be optimised. Nurse coordinated care is proven to be effective, especially where they work in an interdisciplinary way with other health professionals such as doctors, pharmacists and psychologists, who provide equally important expertise for supporting holistic care. Successful care models are those that comprehensively target all adverse lifestyles and risk factors that are responsible for the development of cardiovascular disease. These characteristics should be reflected in the standards and core components of prevention and rehabilitation programmes.
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Affiliation(s)
- Catriona Jennings
- 1 National Heart and Lung Institute, Imperial College London, London, UK
| | - Felicity Astin
- 2 Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield and Calderdale & Huddersfield NHS Foundation Trust, Huddersfield, UK
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What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. Int J Nurs Stud 2018; 78:76-83. [DOI: 10.1016/j.ijnurstu.2017.10.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/17/2017] [Indexed: 11/20/2022]
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Mills KT, Obst KM, Shen W, Molina S, Zhang HJ, He H, Cooper LA, He J. Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis. Ann Intern Med 2018; 168:110-120. [PMID: 29277852 PMCID: PMC5788021 DOI: 10.7326/m17-1805] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The prevalence of hypertension is high and is increasing worldwide, whereas the proportion of controlled hypertension is low. PURPOSE To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. DATA SOURCES Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restrictions, supplemented with manual reference searches. STUDY SELECTION Randomized controlled trials lasting at least 6 months comparing the effect of implementation strategies versus usual care on BP reduction in adults with hypertension. DATA EXTRACTION Two investigators independently extracted data and assessed study quality. DATA SYNTHESIS A total of 121 comparisons from 100 articles with 55 920 hypertensive patients were included. Multilevel, multicomponent strategies were most effective for systolic BP reduction, including team-based care with medication titration by a nonphysician (-7.1 mm Hg [95% CI, -8.9 to -5.2 mm Hg]), team-based care with medication titration by a physician (-6.2 mm Hg [CI, -8.1 to -4.2 mm Hg]), and multilevel strategies without team-based care (-5.0 mm Hg [CI, -8.0 to -2.0 mm Hg]). Patient-level strategies resulted in systolic BP changes of -3.9 mm Hg (CI, -5.4 to -2.3 mm Hg) for health coaching and -2.7 mm Hg (CI, -3.6 to -1.7 mm Hg) for home BP monitoring. Similar trends were seen for diastolic BP reduction. LIMITATION Sparse data from low- and middle-income countries; few trials of some implementation strategies, such as provider training; and possible publication bias. CONCLUSION Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and should be used to improve hypertension control. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Katherine T Mills
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine M Obst
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Wei Shen
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Sandra Molina
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Hui-Jie Zhang
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Hua He
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa A Cooper
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
| | - Jiang He
- From Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute, New Orleans, Louisiana; Nanjing Medical University School of Public Health, Nanjing, China; The First Affiliated Hospital of Xiamen University, Xiamen, China; and Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland
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Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial. Int J Nurs Stud 2018; 77:171-178. [DOI: 10.1016/j.ijnurstu.2017.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 02/03/2023]
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Tabesh M, Shaw JE, Zimmet PZ, Soderberg S, Kowlessur S, Timol M, Joonas N, Alberti GMM, Tuomilehto J, Shaw BJ, Magliano DJ. Meeting American Diabetes Association diabetes management targets: trends in Mauritius. Diabet Med 2017; 34:1719-1727. [PMID: 28792634 DOI: 10.1111/dme.13447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/19/2022]
Abstract
AIMS To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015. METHODS Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA1c , blood pressure and LDL cholesterol. RESULTS In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009. CONCLUSIONS In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.
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Affiliation(s)
- M Tabesh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P Z Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - S Soderberg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Public Health and Clinical Medicine, Umeå University and Heart Center, Umeå, Sweden
| | - S Kowlessur
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - M Timol
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - N Joonas
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - G M M Alberti
- Department of Endocrinology and Metabolism, St Mary's Hospital and Imperial College, London, UK
| | - J Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Neurosciences and Preventive Medicine, Danube-University Krems, Austria
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - B J Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - D J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e13-e115. [PMID: 29133356 DOI: 10.1161/hyp.0000000000000065] [Citation(s) in RCA: 1556] [Impact Index Per Article: 222.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:1269-1324. [PMID: 29133354 DOI: 10.1161/hyp.0000000000000066] [Citation(s) in RCA: 2113] [Impact Index Per Article: 301.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:2199-2269. [PMID: 29146533 DOI: 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 618] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:e127-e248. [PMID: 29146535 DOI: 10.1016/j.jacc.2017.11.006] [Citation(s) in RCA: 3016] [Impact Index Per Article: 430.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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He J, Irazola V, Mills KT, Poggio R, Beratarrechea A, Dolan J, Chen CS, Gibbons L, Krousel-Wood M, Bazzano LA, Nejamis A, Gulayin P, Santero M, Augustovski F, Chen J, Rubinstein A. Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial. JAMA 2017; 318:1016-1025. [PMID: 28975305 PMCID: PMC5761321 DOI: 10.1001/jama.2017.11358] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. OBJECTIVE To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. INTERVENTIONS Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. MAIN OUTCOMES AND MEASURES The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. RESULTS Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. CONCLUSIONS AND RELEVANCE Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01834131.
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Jacquelyn Dolan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marie Krousel-Wood
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Analia Nejamis
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Pablo Gulayin
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study. J Hypertens 2017; 35:627-636. [PMID: 27861244 PMCID: PMC5278886 DOI: 10.1097/hjh.0000000000001177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives: This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention. Methods: A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables. Results: Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk ≤20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = −0.44, P < 0.01). Conclusion: The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.
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75
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Carrington MJ, Cohen N, Wiley JF. Blood glucose levels and glycaemic burden in 76,341 patients attending primary care: Bittersweet findings from a 9-year cohort study. Diabetes Res Clin Pract 2017; 127:89-96. [PMID: 28324867 DOI: 10.1016/j.diabres.2017.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 01/20/2023]
Abstract
AIMS Diabetes care is principally applied in the primary care setting whereby we examined trends in glycaemic levels and goals and estimated avoidable glycaemic burden. METHODS We retrieved glycated haemoglobin (HbA1C) results and glucose-lowering prescription records from a patient-based medical database during 2005-2013. There were 275,480 available HbA1C measurements from 76,341 individuals managed by 960 general practitioners from 321 clinics across Australia. Change in mean levels and glycaemic control over time were assessed according to sex, age and glucose-lowering therapy. The time that HbA1C levels exceeded 7% (53mmol/mol) in untreated (n=4888), non-insulin (n=11,534) and insulin treated (n=4049) patients was calculated as area under the curve (AUC) and months above threshold. RESULTS Average age of patients was 62.1±15.1years (47.1% women). HbA1C levels decreased from 7.1% (54mmol/mol) in 2005 to 6.6% (49mmol/mol) in 2013 and the proportion of patients who achieved a HbA1C target of <7% improved by 16% in men (53-69%) and 21% in women (55-76%). HbA1C levels decreased with advancing age in men and increased with insulin treatment; correspondingly, HbA1C goal attainment increased and decreased, respectively. Avoidable glycaemic burden was 9.3±17.7months in untreated, 16.2±25.2months in non-insulin, and 26.8±34.6months in insulin-treated patients. CONCLUSIONS Amid considerable improvements, many treated patients still do not attain HbA1C levels ≤7% and time spent above this threshold was delayed. Earlier and more vigorously intensified management may reduce lengthy periods of uncontrolled hyperglycaemia in primary care.
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Affiliation(s)
- Melinda J Carrington
- Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia.
| | - Neale Cohen
- Baker IDI Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC 8008, Australia.
| | - Joshua F Wiley
- Centre for Primary Care and Prevention, MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring St, Melbourne, VIC 3000, Australia; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Wellington Rd, Clayton, VIC 3800, Australia.
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76
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Mejzner N, Clark CE, Smith LF, Campbell JL. Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England. Br J Gen Pract 2017; 67:e306-e313. [PMID: 28347984 PMCID: PMC5409425 DOI: 10.3399/bjgp17x690461] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/23/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Previous surveys identified a shift to nurse-led care in hypertension in 2010. In 2011 the National Institute for Health and Care Excellence (NICE) recommended ambulatory (ABPM) or home (HBPM) blood pressure (BP) monitoring for diagnosis of hypertension. AIM To survey the organisation of hypertension care in 2016 to identify changes, and to assess uptake of NICE diagnostic guidelines. DESIGN AND SETTING Questionnaires were distributed to all 305 general practices in South West England. METHOD Responses were compared with previous rounds (2007 and 2010). Data from the 2015 Quality and Outcomes Framework (QOF) were used to compare responders with non-responders, and to explore associations of care organisation with QOF achievement. RESULTS One-hundred-and-seventeen practices (38%) responded. Responders had larger list sizes and greater achievement of the QOF target BP ≤150/90 mmHg. Healthcare assistants (HCAs) now monitor BP in 70% of practices, compared with 37% in 2010 and 19% in 2007 (P<0.001). Nurse prescribers alter BP medication in 26% of practices (11% in 2010, none in 2007; P<0.001). Of the practices, 89% have access to ABPM, but only 71% report confidence in interpreting results. Also, 87% offer HBPM, with 93% of these confident in interpreting results. CONCLUSION In primary care BP monitoring has devolved from GPs and nurses to HCAs. One in 10 practices are not implementing NICE guidelines on ABPM and HBPM for diagnosis of hypertension. Most practices express confidence interpreting HBPM results but less so with ABPM. The need for education and quality assurance for allied health professionals is highlighted, and for training in ABPM interpretation for GPs.
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Affiliation(s)
- Natasha Mejzner
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon
| | - Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon
| | - Lindsay Fp Smith
- East Somerset Research Consortium, Westlake Surgery, Yeovil, Somerset
| | - John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon
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Tompson AC, Fleming SG, Heneghan CJ, McManus RJ, Greenfield SM, Hobbs FDR, Ward AM. Current and potential providers of blood pressure self-screening: a mixed methods study in Oxfordshire. BMJ Open 2017; 7:e013938. [PMID: 28336742 PMCID: PMC5372057 DOI: 10.1136/bmjopen-2016-013938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To (1) establish the extent of opportunities for members of the public to check their own blood pressure (BP) outside of healthcare consultations (BP self-screening), (2) investigate the reasons for and against hosting such a service and (3) ascertain how BP self-screening data are used in primary care. DESIGN A mixed methods, cross-sectional study. SETTING Primary care and community locations in Oxfordshire, UK. PARTICIPANTS 325 sites were surveyed to identify where and in what form BP self-screening services were available. 23 semistructured interviews were then completed with current and potential hosts of BP self-screening services. RESULTS 18/82 (22%) general practices offered BP self-screening and 68/110 (62%) pharmacies offered professional-led BP screening. There was no evidence of permanent BP self-screening activities in other community settings.Healthcare professionals, managers, community workers and leaders were interviewed. Those in primary care generally felt that practice-based BP self-screening was a beneficial activity that increased the attainment of performance targets although there was variation in its perceived usefulness for patient care. The pharmacists interviewed provided BP checking as a service to the community but were unable to develop self-screening services without a clear business plan. Among potential hosts, barriers to providing a BP self-screening service included a perceived lack of healthcare commissioner and public demand, and a weak-if any-link to their core objectives as an organisation. CONCLUSIONS BP self-screening currently occurs in a minority of general practices. Any future development of community BP self-screening programmes will require (1) public promotion and (2) careful consideration of how best to support-and reward-the community hosts who currently perceive little if any benefit.
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Affiliation(s)
- A C Tompson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S G Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - C J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - S M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - F D R Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A M Ward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Terbovc A, Gomišček B. Obvladovanje dejavnikov tveganja za nastanek srčno-žilnih bolezni v referenčni ambulanti družinske medicine. OBZORNIK ZDRAVSTVENE NEGE 2017. [DOI: 10.14528/snr.2017.51.1.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Model referenčnih ambulant družinske medicine prinaša spremembe v obravnavi pacientov. Namen raziskave je bil preučiti dejavnike tveganja, ki prispevajo k zmanjšanju nastanka srčno-žilnih bolezni z nefarmakološkimi ukrepi pri pacientih v referenčni ambulanti družinske medicine.
Metode: Narejena je bila retrogradna raziskava podatkov pacientov, ki so bili obravnavani v referenčnih ambulantah za srčno-žilno ogroženost. Naključni raziskovalni vzorec je obsegal 128 pacientov, ki so v obdobju od 1. maja do 25. avgusta 2014 v referenčni ambulanti družinske medicine opravili presejalni in kontrolni pregled. Podatki so bili analizirani z opisno statistiko in hi-kvadrat testom.
Rezultati: Pri obravnavanih pacientih so bili pri kontrolnem pregledu v primerjavi s presejalnim ugotovljeni višji deleži urejenih preiskovanih parametrov, in sicer pri krvnem tlaku (41,6 %), holesterolu (45,5 %) in krvnem sladkorju (53,3 %), zmanjšal se je tudi delež kadilcev, in sicer za 4 %. Visoka srčno-žilna ogroženost (20–40 %) se je pri kontrolni meritvi znižala na 28 %, zelo visoka na 6,6 %. Po obravnavi v ambulanti se je telesna aktivnost, izvajana od 2- do 4-krat na teden, povečala na 54,3 % oz. telesna aktivnost, izvajana 5-krat na teden, na 19,4 %. Statistično značilne razlike so se pokazale pri krvnem tlaku (χ2 = 8,780, p = 0,003) in holesterolu (χ2 = 4,781, p = 0,029).
Diskusija in zaključek: Po ambulantni obravnavi se je pri pacientih pomembno izboljšala vrednost nekaterih dejavnikov tveganja, kar je moč pripisati kakovostni obravnavi, ki jo omogoča model referenčnih ambulant, in vlogi diplomirane medicinske sestre v tem modelu.
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Han L, Ma Y, Wei S, Tian J, Yang X, Shen X, Zhang J, Shi Y. Are home visits an effective method for diabetes management? A quantitative systematic review and meta-analysis. J Diabetes Investig 2017; 8:701-708. [PMID: 28109182 PMCID: PMC5583953 DOI: 10.1111/jdi.12630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/27/2016] [Accepted: 01/17/2017] [Indexed: 01/14/2023] Open
Abstract
AIMS/INTRODUCTION Previous reviews have revealed uncertainty regarding the effectiveness of home visit interventions for managing diabetes. Therefore, we carried out a quantitative systematic review and meta-analysis to evaluate the effects of home visit interventions among patients with diabetes. MATERIALS AND METHODS We searched various electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, Wanfang and Chinese scientific full-text databases) from their inception until March 2016. We included randomized controlled trials that included patients with diabetes, and evaluated the effects of home visit programs on glycated hemoglobin concentrations. Two reviewers independently used the Cochrane Collaboration methods to assess the included studies' risk of bias and quality. RESULTS We included seven randomized controlled trials with 686 participants. Compared with the usual care, the home visit group showed a greater reduction in glycated hemoglobin concentrations (mean difference -0.79% [-9 mmol/mol], 95% confidence interval [CI]: -0.93 to -0.25% [11 to -3 mmol/mol]; P < 0.05; I2 = 0%), systolic blood pressure (mean difference -5.94 mmHg, 95% confidence interval -11.34 to -0.54 mmHg) and diastolic blood pressure (mean difference -6.32 mmHg, 95% confidence interval -12.00 to -0.65 mmHg). Furthermore, home visits improved quality of life, high-density lipoprotein, low-density lipoprotein, total triglycerides and self-management. However, there were no significant differences between the two groups in their bodyweight, total cholesterol, body mass index and self-efficacy. CONCLUSION Home visits were associated with improved glycemic control and reduced cardiovascular risk factors, which shows that it is an effective method for diabetes management.
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Affiliation(s)
- Lin Han
- Nursing Department, Gansu Provincial Hospital, Lanzhou, Gansu, China.,School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.,Medical College, Northwest University for Nationalities, Lanzhou, Gansu, China
| | - Suhong Wei
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaochun Yang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Xiping Shen
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jun Zhang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Yuexian Shi
- Nursing Department, Affiliated Hospital of Medical College of Chinese People's Armed Police Force, Tianjin, China
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Santschi V, Wuerzner G, Chiolero A, Burnand B, Schaller P, Cloutier L, Paradis G, Burnier M. Team-based care for improving hypertension management among outpatients (TBC-HTA): study protocol for a pragmatic randomized controlled trial. BMC Cardiovasc Disord 2017; 17:39. [PMID: 28109266 PMCID: PMC5251291 DOI: 10.1186/s12872-017-0472-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/14/2017] [Indexed: 12/22/2022] Open
Abstract
Background Blood pressure (BP) is poorly controlled among a large proportion of hypertensive outpatients. Innovative models of care are therefore needed to improve BP control. The Team-Based Care for improving Hypertension management (TBC-HTA) study aims to evaluate the effect of a team-based care (TBC) interprofessional intervention, involving nurses, community pharmacists and physicians, on BP control of hypertensive outpatients compared to usual care in routine clinical practice. Methods/design The TBC-HTA study is a pragmatic randomized controlled study with a 6-month follow-up which tests a TBC interprofessionnal intervention conducted among uncontrolled treated hypertensive outpatients in two ambulatory clinics and among seven nearby community pharmacies in Lausanne and Geneva, Switzerland. A total of 110 patients are being recruited and randomized to TBC (TBC: N = 55) or usual care group (UC: N = 55). Patients allocated to the TBC group receive the TBC intervention conducted by an interprofessional team, involving an ambulatory clinic nurse, a community pharmacist and a physician. A nurse and a community pharmacist meet patients every 6 weeks to measure BP, to assess lifestyle, to estimate medication adherence, and to provide education to the patient about disease, treatment and lifestyle. After each visit, the nurse and pharmacist write a summary report with recommendations related to medication adherence, lifestyle, and changes in therapy. The physician then adjusts antihypertensive therapy accordingly. Patients in the UC group receive usual routine care without sessions with a nurse and a pharmacist. The primary outcome is the difference in daytime ambulatory BP between TBC and UC patients at 6-month of follow-up. Secondary outcomes include patients’ and healthcare professionals’ satisfaction with the TBC intervention and BP control at 12 months (6 months after the end of the intervention). Discussion This ongoing study aims to evaluate the effect of a newly developed team-based care intervention engaging different healthcare professionals on BP control in a primary care setting in Switzerland. The results will inform policymakers on implementable strategies for routine clinical practice. Trial registration ClinicalTrials.gov registration: NCT02511093. Retrospectively registered on 28 July 2015.
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Affiliation(s)
- Valérie Santschi
- La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland, Av. Vinet 30, 1004, Lausanne, Switzerland. .,Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Lyne Cloutier
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
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Parekh N, Page A, Ali K, Davies K, Rajkumar C. A practical approach to the pharmacological management of hypertension in older people. Ther Adv Drug Saf 2016; 8:117-132. [PMID: 28439398 DOI: 10.1177/2042098616682721] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing. A novel 'BEGIN' algorithm is proposed for use by prescribers prior to initiating antihypertensive therapy to guide safe medication use in older adults. Practical suggestions are highlighted to aid practitioners in making rational decisions to treat and monitor hypertension, and for considering withdrawal of antihypertensive drugs in the complex older person.
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Affiliation(s)
| | - Amy Page
- The University of Western Australia, Crawley, Australia
| | - Khalid Ali
- Brighton and Sussex Medical School, Brighton, UK
| | - Kevin Davies
- Brighton and Sussex Medical School, Brighton, UK
| | - Chakravarthi Rajkumar
- Department of Elderly Medicine, Brighton and Sussex Medical School, Audrey Emerton Building, Eastern Road, Brighton BN2 5BE, UK
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Weeks G, George J, Maclure K, Stewart D. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev 2016; 11:CD011227. [PMID: 27873322 PMCID: PMC6464275 DOI: 10.1002/14651858.cd011227.pub2] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A range of health workforce strategies are needed to address health service demands in low-, middle- and high-income countries. Non-medical prescribing involves nurses, pharmacists, allied health professionals, and physician assistants substituting for doctors in a prescribing role, and this is one approach to improve access to medicines. OBJECTIVES To assess clinical, patient-reported, and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). SEARCH METHODS We searched databases including CENTRAL, MEDLINE, Embase, and five other databases on 19 July 2016. We also searched the grey literature and handsearched bibliographies of relevant papers and publications. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, controlled before-and-after (CBA) studies (with at least two intervention and two control sites) and interrupted time series analysis (with at least three observations before and after the intervention) comparing: 1. non-medical prescribing versus medical prescribing in acute care; 2. non-medical prescribing versus medical prescribing in chronic care; 3. non-medical prescribing versus medical prescribing in secondary care; 4 non-medical prescribing versus medical prescribing in primary care; 5. comparisons between different non-medical prescriber groups; and 6. non-medical healthcare providers with formal prescribing training versus those without formal prescribing training. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed studies for inclusion, extracted data, and assessed study quality with discrepancies resolved by discussion. Two review authors independently assessed risk of bias for the included studies according to EPOC criteria. We undertook meta-analyses using the fixed-effect model where studies were examining the same treatment effect and to account for small sample sizes. We compared outcomes to a random-effects model where clinical or statistical heterogeneity existed. MAIN RESULTS We included 46 studies (37,337 participants); non-medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non-medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non-medical prescribing being undertaken by other health professionals. The education requirement for non-medical prescribing varied with country and location.A meta-analysis of surrogate markers of chronic disease (systolic blood pressure, glycated haemoglobin, and low-density lipoprotein) showed positive intervention group effects. There was a moderate-certainty of evidence for studies of blood pressure at 12 months (mean difference (MD) -5.31 mmHg, 95% confidence interval (CI) -6.46 to -4.16; 12 studies, 4229 participants) and low-density lipoprotein (MD -0.21, 95% CI -0.29 to -0.14; 7 studies, 1469 participants); we downgraded the certainty of evidence from high due to considerations of serious inconsistency (considerable heterogeneity), multifaceted interventions, and variable prescribing autonomy. A high-certainty of evidence existed for comparative studies of glycated haemoglobin management at 12 months (MD -0.62, 95% CI -0.85 to -0.38; 6 studies, 775 participants). While there appeared little difference in medication adherence across studies, a meta-analysis of continuous outcome data from four studies showed an effect favouring patient adherence in the non-medical prescribing group (MD 0.15, 95% CI 0.00 to 0.30; 4 studies, 700 participants). We downgraded the certainty of evidence for adherence to moderate due to the serious risk of performance bias. While little difference was seen in patient-related adverse events between treatment groups, we downgraded the certainty of evidence to low due to indirectness, as the range of adverse events may not be related to the intervention and selective reporting failed to adequately report adverse events in many studies.Patients were generally satisfied with non-medical prescriber care (14 studies, 7514 participants). We downgraded the certainty of evidence from high to moderate due to indirectness, in that satisfaction with the prescribing component of care was only addressed in one study, and there was variability of satisfaction measures with little use of validated tools. A meta-analysis of health-related quality of life scores (SF-12 and SF-36) found a difference favouring usual care for the physical component score (MD 1.17, 95% CI 0.16 to 2.17), but not the mental component score (MD 0.58, 95% CI -0.40 to 1.55). However, the quality of life measurement may more appropriately reflect composite care rather than the prescribing component of care, and for this reason we downgraded the certainty of evidence to moderate due to indirectness of the measure of effect. A wide variety of resource use measures were reported across studies with little difference between groups for hospitalisations, emergency department visits, and outpatient visits. In the majority of studies reporting medication use, non-medical prescribers prescribed more drugs, intensified drug doses, and used a greater variety of drugs compared to usual care medical prescribers.The risk of bias across studies was generally low for selection bias (random sequence generation), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), and reporting bias (selective reporting). There was an unclear risk of selection bias (allocation concealment) and for other biases. A high risk of performance bias (blinding of participants and personnel) existed. AUTHORS' CONCLUSIONS The findings suggest that non-medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non-medical prescribers can deliver comparable outcomes for systolic blood pressure, glycated haemoglobin, low-density lipoprotein, medication adherence, patient satisfaction, and health-related quality of life. It was difficult to determine the impact of non-medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient-reported, resource use, and economic outcomes of non-medical prescribing, in both high-income and low-income countries.
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Affiliation(s)
- Greg Weeks
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
- Barwon HealthPharmacy DepartmentGeelongVictoriaAustralia
| | - Johnson George
- Monash UniversityCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesParkvilleVICAustralia3052
| | - Katie Maclure
- Robert Gordon UniversitySchool of PharmacyRiverside EastGarthdee RoadAberdeenUKAB10 7GJ
| | - Derek Stewart
- Robert Gordon UniversitySchool of PharmacyRiverside EastGarthdee RoadAberdeenUKAB10 7GJ
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Wong JYH, Chan MMK, Lok KYW, Ngai VFW, Pang MTH, Chan CKY, Yau JHY, Choi EPH, Fong SSM. Chinese women health ambassadors programme: A process evaluation. J Clin Nurs 2016; 26:2976-2985. [PMID: 27862523 DOI: 10.1111/jocn.13638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to assess a community-women health ambassadors programme and report the areas that were successful and those that required improvement. The objectives were to assess the feasibility, effectiveness, implementation and sustainability of the programme. BACKGROUND Health promotion for the prevention of chronic diseases has always been the top priority in the health sector. To ensure that the relevant health messages are well received in local communities, a health promotion programme must be accessible, acceptable and culturally relevant. DESIGN We conducted and evaluated a women health ambassador programme based on the lay health advisor model for health promotion in Hong Kong during November 2014 to February 2015. Health needs and the subsequent focus of the programme were determined by underprivileged Chinese women. METHODS University health educators from different disciplines trained the women (N = 80) to be health ambassadors through mini-lectures and training workshops. The trained women raised awareness about the importance of health within their families and social networks. The programme was evaluated through attendance rates, questionnaires and quizzes, changes in knowledge and behaviour, as well as qualitative discussion. RESULTS While the majority of participants found the programme valuable and useful, retention rates were unideal. A statistically significant improvement was found in eating habits, but no significant change was identified for other knowledge and behaviour assessments. CONCLUSIONS The programme empowered underprivileged women to reflect on the importance of health, take responsibility for their own health and actively promote health to their families and personal communities. RELEVANCE TO CLINICAL PRACTICE Our study supports that health promotion programmes based on the lay health advisor model are effective and encourage large-scale programmes of this nature. Our results also support that future health promotion efforts should deliver brief, clear and simple content as opposed to intricate information.
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Affiliation(s)
- Janet Yuen Ha Wong
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Maggie Mee Kie Chan
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kris Yuet Wan Lok
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Vivian Fei Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Michelle Tsz Ha Pang
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Claudia Kor Yee Chan
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Jessie Ho Yin Yau
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Edmond Pui Hang Choi
- Li Ka Shing Faculty of Medicine, School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Shirley Siu Ming Fong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Choi H, Kim J. Effectiveness of telemedicine: videoconferencing for low-income elderly with hypertension. Telemed J E Health 2016; 20:1156-64. [PMID: 25469880 DOI: 10.1089/tmj.2014.0031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Develop educational materials and a classification system for remote consultations and home-based healthcare through videoconferencing, manage the blood pressure of patients through a ubiquitous-health (u-health) service, and identify its effects on the blood pressure and level of depression of the service recipients (i.e., low-income elderly patients with hypertension). MATERIALS AND METHODS This study is a nonequivalent control group pre-test-post-test, quasi-experimental study. Low-income essential hypertensive patients above 65 years of age living in public rental housing were our target group. They were divided into two groups: an experimental group of 25 who had received blood pressure monitoring as well as inbound-outbound remote video consultation and a control group of 24 who received blood pressure monitoring through u-health equipment but no other management. In total, 16 sessions were conducted twice a week for 8 weeks. RESULTS (1) The hypothesis that there would be a difference in the level of depression between the control group and the experimental group who received the u-health service was rejected because of the lack of a significant statistical difference (t=-0.142, p=0.889). However, there was a significant difference before and after the service in the experimental group (t=2.49, p=0.021). (2) Concerning the second hypothesis-that there would be a difference in systolic and diastolic blood pressure between the control group and the experimental group-there was a statistically significant decrease in systolic blood pressure (F=10.26, p=0.003), but diastolic blood pressure showed no significant difference (F=2.802, p=0.101). Thus, the hypothesis was partially adopted. (3) The third hypothesis stated that the rates of sleep (p=0.012) and hobbies (p=0.036) as aspects of a healthy lifestyle in the experimental group would be significantly higher than those of the control group. CONCLUSIONS These findings confirm that the u-health nursing service via videoconferencing made a measurable contribution to a healthier lifestyle by reducing systolic blood pressure levels compared with those who were only monitored for high blood pressure. Therefore, this service is recommended as part of a hypertension management regimen for low-income elderly people as an effective means of nursing intervention.
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Affiliation(s)
- Hanna Choi
- College of Nursing, Seoul National University , Seoul, South Korea
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Vedanthan R, Tuikong N, Kofler C, Blank E, Kamano JH, Naanyu V, Kimaiyo S, Inui TS, Horowitz CR, Fuster V. Barriers and Facilitators to Nurse Management of Hypertension: A Qualitative Analysis from Western Kenya. Ethn Dis 2016; 26:315-22. [PMID: 27440970 PMCID: PMC4948797 DOI: 10.18865/ed.26.3.315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension is the leading global risk for mortality. Poor treatment and control of hypertension in low- and middle-income countries is due to several reasons, including insufficient human resources. Nurse management of hypertension is a novel approach to address the human resource challenge. However, specific barriers and facilitators to this strategy are not known. OBJECTIVE To evaluate barriers and facilitators to nurse management of hypertensive patients in rural western Kenya, using a qualitative research approach. METHODS Six key informant interviews (five men, one woman) and seven focus group discussions (24 men, 33 women) were conducted among physicians, clinical officers, nurses, support staff, patients, and community leaders. Content analysis was performed using Atlas.ti 7.0, using deductive and inductive codes that were then grouped into themes representing barriers and facilitators. Ranking of barriers and facilitators was performed using triangulation of density of participant responses from the focus group discussions and key informant interviews, as well as investigator assessments using a two-round Delphi exercise. RESULTS We identified a total of 23 barriers and nine facilitators to nurse management of hypertension, spanning the following categories of factors: health systems, environmental, nurse-specific, patient-specific, emotional, and community. The Delphi results were generally consistent with the findings from the content analysis. CONCLUSION Nurse management of hypertension is a potentially feasible strategy to address the human resource challenge of hypertension control in low-resource settings. However, successful implementation will be contingent upon addressing barriers such as access to medications, quality of care, training of nurses, health education, and stigma.
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Affiliation(s)
| | - Nelly Tuikong
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Claire Kofler
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Evan Blank
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Jemima H. Kamano
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Violet Naanyu
- Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Thomas S. Inui
- Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, USA
| | | | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, New York, USA
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Carrington MJ, Jennings GL, Harris M, Nelson M, Schlaich M, Stocks NP, Burrell LM, Amerena J, de Looze FJ, Swemmer CH, Kurstjens NP, Stewart S. Impact of nurse-mediated management on achieving blood pressure goal levels in primary care: Insights from the Valsartan Intensified Primary carE Reduction of Blood Pressure Study. Eur J Cardiovasc Nurs 2016; 15:409-16. [DOI: 10.1177/1474515115591901] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Melinda J Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Mark Nelson
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Markus Schlaich
- School of Medicine and Pharmacology, Royal Perth Hospital Unit, The University of Western Australia, Australia
| | - Nigel P Stocks
- Discipline of General Practice, University of Adelaide, Australia
| | - Louise M Burrell
- Departments of Medicine and Cardiology, The University of Melbourne, Austin Health, Australia
| | - John Amerena
- Geelong Cardiology Research Department, Deakin University, Australia
| | | | | | | | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Perl S, Niederl E, Kos C, Mrak P, Ederer H, Rakovac I, Beck P, Kraler E, Stoff I, Klima G, Pieske BM, Pieber TR, Zweiker R. Randomized Evaluation of the Effectiveness of a Structured Educational Program for Patients With Essential Hypertension. Am J Hypertens 2016; 29:866-72. [PMID: 26643687 DOI: 10.1093/ajh/hpv186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/05/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adherence to medication and lifestyle interventions are essential keys for the management of hypertension. In this respect, a structured educational program for hypertensive patients has got remarkable merits (herz.leben). In order to determine the isolated effect of participation in the educational program, neglecting the possible impact of more intense care, this prospective multicenter randomized controlled study was designed (NCT00453037). METHODS A total of 256 patients in 13 centers were enrolled and randomly assigned to 2 groups (G). G-I (n = 137) underwent the educational program immediately (T-0), G-II (n = 119) after 6 months (T-6). Follow-up visits were done after 6 (T-6) and 12 (T-12) months. Primary endpoint was a difference in office blood pressure (BP) at T-6, when only G-I had undergone the educational program. RESULTS Patients' baseline characteristics were comparable. At T-6, systolic office and home BP were significantly lower in G-I compared to G-II: office BP systolic 139 (134-150) mm Hg vs. 150 (135-165) mm Hg (P < 0.01); diastolic 80 (76-85) mm Hg vs. 84 (75-90) mm Hg (ns); home BP systolic 133 (130-140) mm Hg vs. 142 (132-150) mm Hg (P < 0.01); diastolic 80 (75-85) mm Hg vs. 80 (76-89) mm Hg (ns)). At T-12, when all patients had undergone the educational program differences in BP disappeared. CONCLUSION The results of this multicenter randomized controlled study provide significant evidence for benefit by participation in a structured educational program. Positive effects seem to be mediated by better adherence and life style changes due to higher levels of information and patient empowerment. Therefore, educational strategies should be considered as standard of care for hypertensive patients.
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Affiliation(s)
- Sabine Perl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria;
| | - Ella Niederl
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Cornelia Kos
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Ivo Rakovac
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Peter Beck
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Elisabeth Kraler
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ingrid Stoff
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gert Klima
- Public Health Fund Styria, Graz, Austria
| | - Burkert M Pieske
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Joanneum Research Forschungsgesellschaft mbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria; Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Robert Zweiker
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Expanding the Role of Nurses to Improve Hypertension Care and Control
Globally. Ann Glob Health 2016; 82:243-53. [DOI: 10.1016/j.aogh.2016.02.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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90
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Solomon DH, Fraenkel L, Lu B, Brown E, Tsao P, Losina E, Katz JN, Bitton A. Comparison of Care Provided in Practices With Nurse Practitioners and Physician Assistants Versus Subspecialist Physicians Only: A Cohort Study of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2016; 67:1664-70. [PMID: 26096922 DOI: 10.1002/acr.22643] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 05/11/2015] [Accepted: 06/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The Affordable Care Act proposes wider use of nurse practitioners (NPs) and physician assistants (PAs), but little is known about outcomes of care provided by them in medical specialties. We compared the outcomes of care for patients with rheumatoid arthritis (RA) seen in practices with NPs or PAs and rheumatologists versus practices with rheumatologists only. METHODS We enrolled 7 rheumatology practices in the US (4 with NPs or PAs and 3 without). RA disease activity (categorized as in remission, low, moderate, or high, using standardized measures) was abstracted from medical records from the most recent 2 years. We performed a repeated-measures analysis using generalized linear regression to compare disease activity for visits to practices with NPs or PAs versus rheumatologist-only practices, adjusting for disease duration, serologic status, RA treatments, and disease activity measures. RESULTS Records from 301 patients, representing 1,982 visits, were reviewed. The patients' mean age was 61 years and 77% were female. In the primary adjusted analysis, patients seen in practices with NPs or PAs were less likely to have higher disease activity (odds ratio 0.32, 95% confidence interval 0.17-0.60; P = 0.004) than those seen in rheumatologist-only practices. However, there were no differences in the change in disease activity. CONCLUSION Patients seen in practices with NPs or PAs had lower RA disease activity over 2 years compared to those seen in rheumatologist-only practices; no differences were observed in the change in disease activity between visits either within or between the different types of provider practice.
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Affiliation(s)
| | | | - Bing Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Erika Brown
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Peter Tsao
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Elena Losina
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Asaf Bitton
- Brigham and Women's Hospital, Boston, Massachusetts
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91
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Uchmanowicz I, Jankowska-Polańska B, Chudiak A, Szymańska-Chabowska A, Mazur G. Psychometric evaluation of the Polish adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. BMC Cardiovasc Disord 2016; 16:87. [PMID: 27165782 PMCID: PMC4862115 DOI: 10.1186/s12872-016-0270-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/29/2016] [Indexed: 11/28/2022] Open
Abstract
Background Development of simple instruments for the determination of the level of adherence in patients with high blood pressure is the subject of ongoing research. One such instrument, gaining growing popularity worldwide, is the Hill-Bone Compliance to High Blood Pressure Therapy. The aim of this study was to adapt and to test the reliability of the Polish version of Hill-Bone Compliance to High Blood Pressure Therapy Scale. Methods A standard guideline was used for the translation and cultural adaptation of the English version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale into Polish. The study included 117 Polish patients with hypertension aged between 27 and 90 years, among them 53 men and 64 women. Cronbach’s alpha was used for analysing the internal consistency of the scale. Results The mean score in the reduced sodium intake subscale was M = 5.7 points (standard deviation SD = 1.6 points). The mean score in the appointment-keeping subscale was M = 3.4 points (standard deviation SD = 1.4 points). The mean score in the medication-taking subscale was M = 11.6 points (standard deviation SD = 3.3 points). In the principal component analysis, the three-factor system (1 – medication-taking, 2 – appointment-keeping, 3 – reduced sodium intake) accounted for 53 % of total variance. All questions had factor loadings > 0.4. The medication-taking subscale: most questions (6 out of 9) had the highest loadings with Factor 1. The appointment-keeping subscale: all questions (2 out of 2) had the highest loadings with Factor 2. The reduced sodium intake subscale: most questions (2 out of 3) had the highest loadings with Factor 3. Goodness of fit was tested at chi2 = 248.87; p < 0.001. The Cronbach’s alpha score for the entire questionnaire was 0.851. Conclusion The Hill-Bone Compliance to High Blood Pressure Therapy Scale proved to be suitable for use in the Polish population. Use of this screening tool for the assessment of adherence to BP treatment is recommended.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
| | - Anna Chudiak
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
| | - Anna Szymańska-Chabowska
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland.
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland
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Dehmer SP, Baker-Goering MM, Maciosek MV, Hong Y, Kottke TE, Margolis KL, Will JC, Flottemesch TJ, LaFrance AB, Martinson BC, Thomas AJ, Roy K. Modeled Health and Economic Impact of Team-Based Care for Hypertension. Am J Prev Med 2016; 50:S34-S44. [PMID: 27102856 PMCID: PMC8456755 DOI: 10.1016/j.amepre.2016.01.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/19/2016] [Accepted: 01/29/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Team-based interventions for hypertension care have been widely studied and shown effective in improving hypertension outcomes. Few studies have evaluated long-term effects of these interventions; none have assessed broad-scale implementation. This study estimates the prospective health, economic, and budgetary impact of universal adoption of a team-based care intervention model that targets people with treated but uncontrolled hypertension in the U.S. METHODS Analysis was conducted in 2014-2015 using a microsimulation model, constructed with various data sources from 1948 to 2014, designed to evaluate prospective cardiovascular disease (CVD)-related interventions in the U.S. POPULATION Ten-year primary outcomes included prevalence of uncontrolled hypertension; incident myocardial infarction, stroke, CVD events, and CVD-related mortality; intervention and net medical costs by payer; productivity; and quality-adjusted life years. RESULTS About 4.7 million (13%) fewer people with uncontrolled hypertension and 638,000 prevented cardiovascular events would be expected over 10 years. Assuming $525 per enrollee, implementation would cost payers $22.9 billion, but $25.3 billion would be saved in averted medical costs. Estimated net cost savings for Medicare approached $5.8 billion. Net costs were especially sensitive to intervention costs, with break-even thresholds of $300 (private), $450 (Medicaid), and $750 (Medicare). CONCLUSIONS Nationwide adoption of team-based care for uncontrolled hypertension could have sizable effects in reducing CVD burden. Based on the study's assumptions, the policy would be cost saving from the perspective of Medicare and may prove to be cost effective from other payers' perspectives. Expected net cost savings for Medicare would more than offset expected net costs for all other insurers.
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Affiliation(s)
| | | | | | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia
| | | | | | - Julie C Will
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia
| | | | | | | | | | - Kakoli Roy
- Office of the Associate Director for Policy, CDC, Atlanta, Georgia
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Feldman PH, McDonald MV, Barrón Y, Gerber LM, Peng TR. Home-based interventions for black patients with uncontrolled hypertension: a cluster randomized controlled trial. J Comp Eff Res 2016; 5:155-68. [PMID: 26946952 DOI: 10.2217/cer.15.60] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Assess the comparative effectiveness of two blood pressure (BP) control interventions for black patients with uncontrolled hypertension. PATIENTS & METHODS A total of 845 patients were enrolled in a three-arm cluster randomized trial. On admission of an eligible patient, field nurses were randomized to usual care, a basic or augmented intervention. RESULTS Across study arms there were no significant 12 months differences in BP control rates (primary outcome) (25% usual care, 26% basic intervention, 22% augmented intervention); systolic BP (143.8 millimeters of mercury [mmHg], 146.9 mmHG, 143.9 mmHG, respectively); medication intensification (47, 43, 54%, respectively); or self-management score (18.7, 18.7, 17.9, respectively). Adjusted systolic BP dropped more than 10 mmHg from baseline to 12 months (155.5-145.4 mmHg) among all study participants. CONCLUSION Neither the augmented nor basic intervention was more effective than usual care in improving BP control, systolic BP, medication intensification or patient self-management. Usual home care yielded substantial improvements, creating a high comparative effectiveness threshold. CLINICAL TRIAL REGISTRATION NCT00139490.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
| | - Linda M Gerber
- Department Healthcare Policy & Research, Weill Cornell Medical College, New York, NY 10065, USA
| | - Timothy R Peng
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY 10021, USA
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Voogdt-Pruis HR, Beusmans GHMI, Gorgels APM, van Ree JW. Experiences of doctors and nurses implementing nurse-delivered cardiovascular prevention in primary care: a qualitative study. J Adv Nurs 2016; 67:1758-66. [PMID: 21545701 DOI: 10.1111/j.1365-2648.2011.05627.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM This paper reports on a study of the experiences of general practitioners and practice nurses implementing nurse-delivered cardiovascular prevention to high risk patients in primary care. BACKGROUND Difficulties may arise when innovations are introduced into routine daily practice. Whether or not implementation is successful is determined by different factors related to caregivers, patients, type of innovation and context. METHODS A qualitative study nested in a randomized trial (2006-2008) to evaluate the effectiveness of nurse-delivered cardiovascular prevention. Six primary health care centres in the Netherlands (25 general practitioners, 6 practice nurses) participated in the trial. Interviews were held on two occasions: at 3 and at 18 months after commencement of consultation. The first occasion was a group interview with six practice nurses. The second consisted of semi-structured interviews with one general practitioner and one practice nurse from each centre. FINDINGS Main barriers to the implementation included: lack of knowledge about the guideline, attitudes towards treatment targets, lack of communication, insufficient coaching by doctors, content of life style advice. At the start of the consultation project, practice nurses expressed concern of losing nursing tasks. Other barriers were related to patients (lack of motivation), the guideline (target population) and organizational issues (insufficient patient recording and computer systems). CONCLUSIONS Both general practitioners and practice nurses were positive about nurse-delivered cardiovascular prevention in primary care. Nurses could play an important role in successive removal of barriers to implementation of cardiovascular prevention. Mutual confidence between care providers in the healthcare team is necessary.
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Affiliation(s)
- Helene R Voogdt-Pruis
- Researcher Department of Integrated Health Care, Maastricht University Medical Centre/CAPHRI, The Netherlands
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Abstract
Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries. The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in low- and middle-income countries. Barriers at the patient, healthcare provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD, will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including (1) effective measures for tobacco control, (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of healthcare through task-sharing (nonphysician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above will lead to substantial reductions in CVD and related mortality.
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Affiliation(s)
- J D Schwalm
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.).
| | - Martin McKee
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
| | - Mark D Huffman
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
| | - Salim Yusuf
- From Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (J.D.S., S.Y.); Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom (M.M.); and Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (M.D.H.)
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Affiliation(s)
- Ismália de Sousa
- Clinical Nurse Specialist, Imperial College Healthcare NHS Trust
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97
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Katende G, Becker K. Nurse-led care interventions for high blood pressure control: Implications for non-communicable disease programs in Uganda. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2016. [DOI: 10.1016/j.ijans.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Al-Mallah MH, Farah I, Al-Madani W, Bdeir B, Al Habib S, Bigelow ML, Murad MH, Ferwana M. The Impact of Nurse-Led Clinics on the Mortality and Morbidity of Patients with Cardiovascular Diseases. J Cardiovasc Nurs 2016; 31:89-95. [DOI: 10.1097/jcn.0000000000000224] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Parro-Moreno A, Serrano-Gallardo P, Díaz-Holgado A, Aréjula-Torres JL, Abraira V, Santiago-Pérez IM, Morales-Asencio JM. Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis. BMJ Open 2015; 5:e009126. [PMID: 26644122 PMCID: PMC4679997 DOI: 10.1136/bmjopen-2015-009126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). DESIGN Cross-sectional analytical study. SETTING Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. PARTICIPANTS 76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. PRIMARY OUTCOME MEASURE Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE. RESULTS The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). CONCLUSIONS A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed.
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Affiliation(s)
- Ana Parro-Moreno
- Department of Nursing, Department of Preventive Medicine and Public Health, Department of Surgery, School of Medicine, Universidad Autónoma de Madrid/IISPHM, Madrid, Spain
| | - Pilar Serrano-Gallardo
- Department of Nursing, School of Medicine, Universidad Autónoma de Madrid/IDIPHIM/INAECU, Madrid, Spain
| | - Antonio Díaz-Holgado
- Information System Unit, Directorate for Public Health, Health Service of Madrid, Spain
| | - Jose L Aréjula-Torres
- Information System Unit, Directorate for Public Health, Health Service of Madrid, Spain
| | - Victor Abraira
- Clinical Biostatistics of Ramón y Cajal University Hospital/IRYCIS/Centre for Biomedical Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Isolina M Santiago-Pérez
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain/IBIMA, A Coruña, Santiago de Compostela, Spain
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Effectiveness of a multidisciplinary intervention to improve hypertension control in an urban underserved practice. ACTA ACUST UNITED AC 2015; 9:966-74. [DOI: 10.1016/j.jash.2015.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/24/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022]
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