[Effectiveness of nursing appointments in adherence to hypertension treatment]

OBJECTIVE

To assess adherence to both drug and non-drug therapy by users of primary care services diagnosed with systemic arterial hypertension before and after the implementation of systematic nursing appointments.

MATERIAL AND METHODS

Open clinical trial held in a Family Health Strategy center of the state of Minas Gerais, in which 14 participants were followed up through systematic nursing care from October 2016 to September 2017.

RESULTS

Data showed a statistically significant difference in adherence to systemic arterial hypertension therapy after conducting nursing interventions (p=0,102), both individually and in group. The most prevalent nursing diagnoses were "Readiness for enhanced health literacy" and "Sedentary lifestyle".

CONCLUSION

Systematic nursing care may benefit people diagnosed with systemic arterial hypertension treated by primary care services. It is necessary to consolidate the use of nursing processes as well as the nurse identity in the context of chronic care.

[Effects of lifestyle interventions for arterial hypertension in primary care: A systematic review]

BACKGROUND

The proportion of adults suffering from hypertension worldwide was estimated at 31.1 % in 2010. The aim of this study was to evaluate the effects of lifestyle changes in patients with arterial hypertension (AH) in primary care.

MATERIAL AND METHODS

Systematic literature search in the online databases PubMed, Embase, Cochrane and Opengrey. Only randomized controlled trials of the years 2005 to 2017 in German or English were considered.

RESULTS

11 studies out of 458 identified references were evaluated. The patient groups investigated were very heterogeneous and underwent different types of intervention. Educating patients about the clinical picture, regular self-measurements of blood pressure, or patient memories of maintaining a healthy lifestyle have been used most frequently.

CONCLUSION

There is a need for further studies focusing on primary care. However, many lifestyle interventions seem to show very good effects in patients with pre-existing AH (secondary prophylaxis), so these measures should form the basis of antihypertensive therapy in all patients with AH. In addition, it is important to maintain advice on a healthy lifestyle during drug therapy.

Efficacy of empowerment strategies for patients with hypertension: A systematic review and meta-analysis

BACKGROUND

Cardiovascular disease has caused heavy health care burdens in many countries, and hypertension (HTN) is a well-known independent cardiovascular risk factor.

OBJECTIVE

To assess the efficacy of empowerment strategies that affect systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), quality of life, and self-management behaviours for patients with hypertension.

METHODS

A literature search of the Cochrane Library, PubMed, MEDLINE, Embase, Web of Science, and several Chinese medical databases was performed. Study screening, quality assessment, data extraction, and meta-analysis were conducted according to Cochrane standards.

RESULTS

Eleven randomised controlled trials with 988 subjects were identified. Relative to control groups, the empowerment strategies showed significant decreases in SBP (the mean difference [MD] = 9.46, 95 % confidence interval [CI] = 6.36-12.55, p <  0.00001) and DBP (MD = 6.68, 95 % CI = 3.07-10.29, p =  0.0003). However, no significant difference was found in BMI (p = 0.05). Subgroup analysis showed significant differences in the improvement of both SBP and DBP among the various groups, regardless of the duration and type of interventions.

DISCUSSION

Empowerment strategies can decrease both SBP and DBP in hypertension patients. However, its influence on patients' BMI, quality of life, and self-management behaviour remains unclear.

PRACTICAL VALUE

Empowerment strategies are useful for controlling the blood pressure of hypertension patients.

Exploring patient empowerment

Purpose

The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.

Design/methodology/approach

The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.

Findings

This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.

Research limitations/implications

The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.

Practical implications

The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.

Originality/value

The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

Developing personal sense of risk: a grounded theory in men with hypertension

BACKGROUND

For older men with hypertension living in rural areas, non-adherence to treatment is a common phenomenon. The experience on risk perception of individuals with their condition is recognized as playing a critical role in promoting treatment adherence. However, the experience on risk perception in a cohort of older men with hypertension seems unclear.

AIM

To develop a theory concerning risk perception experience in a cohort of older men with hypertension from a rural area of Thailand.

METHODS

A grounded theory approach was used. Semi-structured, face-to-face interviews with 29 hypertensive older men were conducted in Thailand using purposive and theoretical sampling methods. The grounded theory analytical method that included initial and focused coding, and constant comparison was used to analyse the data.

FINDINGS

'Developing a personal sense of risk' emerged as a core category, which incorporated the related four subprocesses: comparing healthcare provider information with stories of people with hypertension, comparing one's own situation with stories of people with hypertension, changing personal sense of risk and changing risk-related behaviour. Older men selected to focus on one particular outcome, using the selected outcome to monitor their risk.

CONCLUSION

This investigation provides a theory for healthcare providers to understand older men's perceptions of personal risk for complications of hypertension. A personal sense of risk influences risk-related behaviour change.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The findings can be used in assessing a personal sense of risk and promoting treatment adherence in older men with hypertension. Effective storytelling intervention, a standard tool for assessment personal sense of risk in older men with hypertension, should be developed. Hypertension care policy needs to be developed for individualized approaches.