The effect of continuous nursing intervention guided by chronotherapeutics on ambulatory blood pressure of older hypertensive patients in the community

Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review

BACKGROUND

Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs.

METHODS

Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results.

RESULTS

198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%).

CONCLUSION

Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

A systematic review of community nursing interventions focusing on improving outcomes for individuals exhibiting risk factors of cardiovascular disease

OBJECTIVE

To examine the role of community-based nursing interventions in improving outcomes for community-dwelling individuals exhibiting risk factors of cardiovascular disease (CVD).

DESIGN

A systematic review and narrative synthesis.

DATA SOURCES

Seven electronic databases (MEDLINE, CINAHL, Global Health, LILACS, Africa-Wide Information, IMEMR, and WPRIM) were searched from inception to 16 March 2018.

REVIEW METHODS

This review included outcomes from studies that were led by or delivered primarily by nurses for individuals exhibiting risk factors of CVD in community settings. At least two independent reviewers performed study selection, data extraction and risk of bias.

RESULTS

46 studies met the eligibility criteria. Community nursing interventions were found to be effective in improving clinical outcomes of symptom control, symptom awareness, symptom management, and social outcomes. Effective interventions were found to be facilitated by a community-centric approach, participant empowerment, reinforcement strategies, a targeted approach towards underserved populations, and home visits. These resulted in positive outcomes such as significant reductions in HbA1c for diabetic patients, attainment of blood pressure targets for hypertensive patients and greater improvement in self-reported dietary intake for patients with hyperlipidaemia.

CONCLUSION

Community-based nurse-led interventions can result in positive outcomes for patients with risk factors of CVD. However, the success of such interventions needs to be facilitated by appropriate funding, thoughtful intervention design and training opportunities for nurses.

IMPACT

Community-based nursing interventions are largely effective in improving clinical and social outcomes for community-dwelling individuals with risk factors of CVD.

Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study

OBJECTIVE

To explore nurses' understanding of continuity of care and existing problems in implementation of continuity of care for Chinese elders with chronic illnesses.

DESIGN AND SAMPLE

Cross-sectional survey and semi-structured interview were performed on 15 nurses and older patients and 1,902 older patients between July 2010 and February 2011.

MEASURES

Semi-structured interview guideline and four-section scale were used.

RESULTS

The interviews showed nurses lacked knowledge of continuity of care, and nurses from small towns or rural areas had less understanding of continuity of care and discharge planning than nurses from central cities. Significant differences were found among patients located in referred areas in selection of medical institutions for treatment, suggesting older adults were more likely to choose general hospitals for treatment. Self-reported surveys demonstrated more than 70% of hospitalized elders chose community hospitals for further recovery after discharge from general hospitals.

CONCLUSIONS

Chinese nurses lack knowledge of continuity of care, and significant discontinuity exists between health care provided by general hospitals, community hospitals and other institutions for elders. A further model for the development of continuity of care should be established that addresses older patients' demands and current barriers in China.