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Lidin M, Michelsen HÖ, Hag E, Stomby A, Schlyter M, Bäck M, Hagström E, Leosdottir M. The Nurses' Role in the Cardiac Rehabilitation Team: Data From the Perfect-CR Study. J Cardiovasc Nurs 2024:00005082-990000000-00201. [PMID: 38912908 DOI: 10.1097/jcn.0000000000001113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Nurses constitute a central profession in the cardiac rehabilitation (CR) team delivering comprehensive CR to individuals with cardiovascular disease. We aimed to identify specific components reflecting the nurses' role in the CR team associated with attainment of risk factor targets post myocardial infarction. METHODS Center-level data (n = 78) was used from the Perfect-CR study, in which structure and processes applied at CR centers in Sweden (including details on the nurses' role) were surveyed. Patient-level data (n = 6755) was retrieved from the SWEDEHEART registry. Associations between structure/processes and target achievement for systolic blood pressure (BP) (<140 mm Hg) and low-density lipoprotein cholesterol (LDL-C, <1.8 mmol/L) at 1 year post myocardial infarction were assessed using logistic regression. RESULTS Structure and processes reflecting nurses' autonomy and role in the CR team associated with patients achieving systolic BP and/or LDL-C targets included the following: nurses having treatment algorithms to adjust BP medication (odds ratio [95% confidence interval]: systolic BP, 1.22 [1.05-1.42]; LDL-C, 1.17 [1.03-1.34]) and lipid-lowering medication (systolic BP, 1.14 [1.00-1.29]; LDL-C, 1.17 [1.05-1.30]), patients having the same nurse throughout follow-up (systolic BP, 1.07 [1.03-1.11]; LDL-C, 1.10 [1.06-1.14]), number of follow-up hours with a nurse (systolic BP, 1.13 [1.07-1.19]), having regular case rounds to discuss patient cases during follow-up (LDL-C, 1.22 [1.09-1.35]), and nurses having training in counseling methods (systolic BP, 1.06 [1.03-1.10]). CONCLUSION Components reflecting CR nurses' autonomy and role in the team are of importance for patients attaining risk factor targets post myocardial infarction. The results could provide guidance for optimizing nurses' competence and responsibilities within the CR team to improve patient care.
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Guo X, Ouyang N, Sun G, Zhang N, Li Z, Zhang X, Li G, Wang C, Qiao L, Zhou Y, Chen Z, Shi C, Liu S, Miao W, Geng D, Zhang P, Sun Y. Multifaceted Intensive Blood Pressure Control Model in Older and Younger Individuals With Hypertension: A Randomized Clinical Trial. JAMA Cardiol 2024:2820165. [PMID: 38888905 PMCID: PMC11195599 DOI: 10.1001/jamacardio.2024.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/12/2024] [Indexed: 06/20/2024]
Abstract
Importance The sustainable effectiveness and safety of a nonphysician community health care practitioner-led intensive blood pressure intervention on cardiovascular disease have not, to the authors' knowledge, been studied, especially in the older adult population. Objective To evaluate such a multifaceted model with a more stringent blood pressure treatment goal (<130/80 mm Hg) among patients aged 60 years and older with hypertension. Design, Setting, and Participants This was a 48-month follow-up study of the China Rural Hypertension Control Project (CRHCP), an open-cluster randomized clinical trial, conducted from 2018 to 2023. Participants 60 years and older and younger than 60 years with a diagnosis of hypertension from the CRHCP trial were included for analysis. Individuals were recruited from 326 villages in rural China. Interventions The well-trained, nonphysician, community health care practitioner implemented a multifaceted intervention program (eg, initiation or titration of antihypertensive medications) to achieve a blood pressure level of less than 130/80 mm Hg, supervised by primary care physicians. Main Outcomes and Measures Cardiovascular disease (a composite of myocardial infarction, stroke, heart failure requiring hospitalization, and cardiovascular disease death). Results A total of 22 386 individuals 60 years and older with hypertension and 11 609 individuals younger than 60 years with hypertension were included in the analysis. The mean (SD) age of the participants was 63.0 (9.0) years and included 20 825 females (61.3%). Among the older individuals with hypertension, a total of 11 289 patients were randomly assigned to the intervention group and 11 097 to the usual-care group. During a median (IQR) of 4.0 (4.0-4.1) years, there was a significantly lower rate of total cardiovascular disease (1133 [2.7%] vs 1433 [3.5%] per year; hazard ratio [HR], 0.75; 95% CI, 0.69-0.81; P < .001) and all-cause mortality (1111 [2.5%] vs 1210 [2.8%] per year; HR, 0.90; 95% CI, 0.83-0.98; P = .01) in the intervention group than in the usual-care group. For patients younger than 60 years, the risk reductions were also significant for total cardiovascular disease (HR, 0.64; 95% CI, 0.56-0.75; P < .001), stroke (HR, 0.64; 95% CI, 0.55-0.76; P < .001), heart failure (HR, 0.39; 95% CI, 0.18-0.87; P = .02), and cardiovascular death (HR, 0.54; 95% CI, 0.37-0.77; P < .001), with all interaction P values for age groups greater than .05. In both age categories, the incidences of injurious falls, symptomatic hypotension, syncope, and the results for kidney outcomes did not differ significantly between groups. Conclusions and Relevance In both the aging and younger general population with hypertension, the nonphysician health care practitioner-led, multifaceted, intensive blood pressure intervention model could effectively and safely reduce the risk of cardiovascular disease and all-cause death. Trial Registration ClinicalTrials.gov Identifier: NCT03527719.
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Affiliation(s)
- Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Nanxiang Ouyang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guozhe Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Naijin Zhang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Zhao Li
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Xingang Zhang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guangxiao Li
- Department of Medical Record Management Center, First Hospital of China Medical University, Shenyang, China
| | - Chang Wang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Lixia Qiao
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Ying Zhou
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Zihan Chen
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Chuning Shi
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Songyue Liu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Wei Miao
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Danxi Geng
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Pengyu Zhang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
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Lindblom S, Ivarsson C, Wändell P, Bergqvist M, Norrman A, Eriksson J, Lund L, Hagströmer M, Hasselström J, Sandlund C, Carlsson AC. Lifestyle counseling in patients with hypertension in primary health care and its association with antihypertensive pharmacotherapy. J Clin Hypertens (Greenwich) 2024. [PMID: 38850281 DOI: 10.1111/jch.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/10/2024]
Abstract
The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.
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Affiliation(s)
- Sebastian Lindblom
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Women´s Health and Allied Health Professionals Theme Karolinska University Hospital, Stockholm, Sweden
| | | | - Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Monica Bergqvist
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Norrman
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Julia Eriksson
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lena Lund
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Maria Hagströmer
- Academic Primary Health Care Centre, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Jan Hasselström
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Christina Sandlund
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
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Lumu W, Bahendeka S, Kibirige D, Wesonga R, Mutebi RK. Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial. Clin Diabetes Endocrinol 2024; 10:16. [PMID: 38764058 PMCID: PMC11103986 DOI: 10.1186/s40842-024-00173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/31/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Hypertension (HT) is an orchestrator of atherosclerotic cardiovascular disease (ASCVD) in people living with type 2 diabetes (T2D). Control of systolic blood pressure (SBP) and HT as a whole is suboptimal in diabetes, partly due to the scarcity of doctors. While nurse-led interventions are pragmatic and cost-effective in the control of HT in primary health care, their effectiveness on SBP control among patients with T2D in Uganda is scantly known. AIM We evaluated the effectiveness of a nurse-led management intervention on SBP among T2D patients with a high ASCVD risk in Uganda. METHODS A two-armed cluster randomized controlled trial compared the nurse-led management intervention with usual doctor-led care. The intervention involved training nurses to provide structured health education, protocol-based HT/CVD management, 24-h phone calls, and 2-monthly text messages for 6 months. The primary outcome was the mean difference in SBP change among patients with T2D with a high ASCVD risk in the intervention and control groups after 6 months. The secondary outcome was the absolute difference in the number of patients at target for SBP, total cholesterol (TC), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), low-density lipoprotein (LDL), triglycerides (TG), and body mass index (BMI) after the intervention. The study was analyzed according to the intention-to-treat principle. Generalized estimating equations were used to assess intra-cluster effect modifiers. Statistical significance was set at 0.05 for all analyses. RESULTS Eight clinics (n = 388 patients) were included (intervention 4 clinics; n = 192; control 4 clinics; n = 196). A nurse-led intervention reduced SBP by -11.21 ± 16.02 mmHg with a mean difference between the groups of -13.75 mmHg (95% CI -16.48 to -11.02, p < 0.001). An increase in SBP of 2.54 ± 10.95 mmHg was observed in the control group. Diastolic blood pressure was reduced by -6.80 ± 9.48 mmHg with a mean difference between groups of -7.20 mmHg (95% C1 -8.87 to -5.48, p < 0.001). The mean differences in the change in ASCVD score and glycated hemoglobin were -4.73% (95% CI -5.95 to -3.51, p = 0.006) and -0.82% (95% CI -1.30 to -0.35, p = 0.001), respectively. There were significant absolute differences in the number of patients at target in SBP (p = 0.001), DBP (p = 0.003), and TC (p = 0.008). CONCLUSION A nurse-led management intervention reduces SBP and ASCVD risk among patients with T2D. Such an intervention may be pragmatic in the screening and management of HT/ASCVD in Uganda. TRIAL REGISTRATION Pan African Clinical Trial Registry, PACTR202001916873358, registered on 6th October 2019.
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Affiliation(s)
- William Lumu
- Department of Internal Medicine, Mengo Hospital, P.O Box 7161, Kampala, Uganda.
| | - Silver Bahendeka
- Mother Kevin Post Graduate Medical School-Uganda Martyrs University, Kampala, Uganda
| | | | - Ronald Wesonga
- School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Ronald Kasoma Mutebi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
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Commodore-Mensah Y, Chen Y, Ogungbe O, Liu X, Metlock FE, Carson KA, Echouffo-Tcheugui JB, Ibe C, Crews D, Cooper LA, Himmelfarb CD. Design and rationale of the cardiometabolic health program linked with community health workers and mobile health telemonitoring to reduce health disparities (LINKED-HEARTS) program. Am Heart J 2024; 275:9-20. [PMID: 38759910 DOI: 10.1016/j.ahj.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. METHODS Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. CONCLUSIONS The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations. TRIAL REGISTRATION ClinicalTrials.gov. Identifier: NCT05321368.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, MD
| | | | - Xiaoyue Liu
- Johns Hopkins University School of Nursing, Baltimore, MD
| | | | - Kathryn A Carson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chidinma Ibe
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deidra Crews
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Lisa A Cooper
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cheryl Dennison Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, MD; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Johns Hopkins University School of Medicine, Baltimore, MD.
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Ito M, Tajika A, Toyomoto R, Imai H, Sakata M, Honda Y, Kishimoto S, Fukuda M, Horinouchi N, Sahker E, Furukawa TA. The short and long-term efficacy of nurse-led interventions for improving blood pressure control in people with hypertension in primary care settings: a systematic review and meta-analysis. BMC PRIMARY CARE 2024; 25:143. [PMID: 38678180 PMCID: PMC11056068 DOI: 10.1186/s12875-024-02380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Previous systematic reviews suggest that nurse-led interventions improve short-term blood pressure (BP) control for people with hypertension. However, the long-term effects, adverse events, and appropriate target BP level are unclear. This study aimed to evaluate the long-term efficacy and safety of nurse-led interventions. METHODS We conducted a systematic review and meta-analysis. We searched the Cochrane Central Register of Controlled Trials, PubMed, and CINAHL, as well as three Japanese article databases, as relevant randomized controlled trials from the oldest possible to March 2021. This search was conducted on 17 April 2021. We did an update search on 17 October 2023. We included studies on adults aged 18 years or older with hypertension. The treatments of interest were community-based nurse-led BP control interventions in addition to primary physician-provided care as usual. The comparator was usual care only. Primary outcomes were long-term achievement of BP control goals and serious adverse events (range: 27 weeks to 3 years). Secondary outcomes were short-term achievement of BP control goals and serious adverse events (range: 4 to 26 weeks), change of systolic and diastolic BP from baseline, medication adherence, incidence of hypertensive complications, and total mortality. RESULTS We included 35 studies. Nurse-led interventions improved long-term BP control (RR 1.10, 95%CI 1.03 to 1.18). However, no significant differences were found in the short-term effects of nurse-led intervention compared to usual care about BP targets. Little information on serious adverse events was available. There was no difference in mortality at both terms between the two groups. Establishing the appropriate target BP from the extant trials was impossible. CONCLUSIONS Nurse-led interventions may be more effective than usual care for achieving BP control at long-term follow-up. It is important to continue lifestyle modification for people with hypertension. We must pay attention to adverse events, and more studies examining appropriate BP targets are needed. Nurse-led care represents an important complement to primary physician-led usual care.
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Affiliation(s)
- Masami Ito
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Aran Tajika
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Rie Toyomoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Hissei Imai
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Masatsugu Sakata
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Yukiko Honda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Social Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Sanae Kishimoto
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Memori Fukuda
- Department of Health Informatics, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Noboru Horinouchi
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Department of General Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Ethan Sahker
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
- Population Health and Policy Research Unit, Medical Education Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.
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Hiura GT, Markossian TW, Probst BD, Tootooni MS, Wozniak G, Rakotz M, Kramer HJ. Age and Comorbidities Are Associated With Therapeutic Inertia Among Older Adults With Uncontrolled Blood Pressure. Am J Hypertens 2024; 37:280-289. [PMID: 37991224 PMCID: PMC10941084 DOI: 10.1093/ajh/hpad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Lack of initiation or escalation of blood pressure (BP) lowering medication when BP is uncontrolled, termed therapeutic inertia (TI), increases with age and may be influenced by comorbidities. METHODS We examined the association of age and comorbidities with TI in 22,665 visits with a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg among 7,415 adults age ≥65 years receiving care in clinics that implemented a hypertension quality improvement program. Generalized linear mixed models were used to determine the association of comorbidity number with TI by age group (65-74 and ≥75 years) after covariate adjustment. RESULTS Baseline mean age was 75.0 years (SD 7.8); 41.4% were male. TI occurred in 79.0% and 83.7% of clinic visits in age groups 65-74 and ≥75 years, respectively. In age group 65-74 years, prevalence ratio of TI with 2, 3-4, and ≥5 comorbidities compared with zero comorbidities was 1.07 (95% confidence interval [CI]: 1.04, 1.12), 1.08 (95% CI: 1.05, 1.12), and 1.15 (95% CI: 1.10, 1.20), respectively. The number of comorbidities was not associated with TI prevalence in age group ≥75 years. After implementation of the improvement program, TI declined from 80.3% to 77.2% in age group 65-74 years and from 85.0% to 82.0% in age group ≥75 years (P < 0.001 for both groups). CONCLUSIONS TI was common among older adults but not associated with comorbidities after age ≥75 years. A hypertension improvement program had limited impact on TI in older patients.
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Affiliation(s)
- Grant T Hiura
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Talar W Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Beatrice D Probst
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
- Department of Emergency Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Mohammad Samie Tootooni
- Department of Health Informatics and Data Science, Loyola University Chicago, Maywood, Illinois, USA
| | - Gregory Wozniak
- Department of Medicine, American Medical Association, Chicago, Illinois, USA
| | - Michael Rakotz
- Department of Medicine, American Medical Association, Chicago, Illinois, USA
| | - Holly J Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
- Department of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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Bulto LN, Roseleur J, Noonan S, Pinero de Plaza MA, Champion S, Dafny HA, Pearson V, Nesbitt K, Gebremichael LG, Beleigoli A, Gulyani A, Schultz T, Hines S, Clark RA, Hendriks JM. Effectiveness of nurse-led interventions versus usual care to manage hypertension and lifestyle behaviour: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2024; 23:21-32. [PMID: 37130339 DOI: 10.1093/eurjcn/zvad040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/04/2023]
Abstract
AIMS This review aimed to investigate the effectiveness of nurse-led interventions vs. usual care on hypertension management, lifestyle behaviour, and patients' knowledge of hypertension and associated risk factors. METHODS A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), EmCare (Ovid), CINAHL (EBSCO), Cochrane library, and ProQuest (Ovid) were searched from inception to 15 February 2022. Randomized controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI tools. A statistical meta-analysis was conducted using STATA version 17.0. RESULTS A total of 37 RCTs and 9731 participants were included. The overall pooled data demonstrated that nurse-led interventions may reduce systolic blood pressure (mean difference -4.66; 95% CI -6.69, -2.64; I2 = 83.32; 31 RCTs; low certainty evidence) and diastolic blood pressure (mean difference -1.91; 95% CI -3.06, -0.76; I2 = 79.35; 29 RCTs; low certainty evidence) compared with usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions had a positive impact on lifestyle behaviour and effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent. CONCLUSION This review revealed the beneficial effects of nurse-led interventions in hypertension management compared with usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension. REGISTRATION PROSPERO: CRD42021274900.
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Affiliation(s)
- Lemma N Bulto
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Jacqueline Roseleur
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Sara Noonan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Maria Alejandra Pinero de Plaza
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, 5005, SA, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Hila Ariela Dafny
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Vincent Pearson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Katie Nesbitt
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Lemlem G Gebremichael
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Alline Beleigoli
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Aarti Gulyani
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Timothy Schultz
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- National Health and Medical Research Council, Transdisciplinary Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, 5005, SA, Australia
| | - Sonia Hines
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
- Flinders Rural and Remote Health, NT. College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
| | - Robyn A Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, 5042, SA, Australia
- Mparntwe Centre for Evidence in Health, A JBI Centre of Excellence, Flinders University, 5 Skinner Street, East Wing, 4066, Alice Springs, Northern Territory, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, 5001, SA, Australia
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Ahmed M, Shafiq A, Zahid M, Dhawadi S, Javaid H, Rehman MEU, Chachar MA, Siddiqi AK. Clinical Outcomes With Nurse-Coordinated Multidisciplinary Care in Patients With Heart Failure: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2024; 49:102041. [PMID: 37595855 DOI: 10.1016/j.cpcardiol.2023.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
The American Heart Association (AHA) and the European Society of Cardiology (ESC) recommend nurse-inclusive multidisciplinary care for patients with heart failure (HF). However, there is no meta-analysis that focuses specifically on the impact of nurse-coordinated multidisciplinary care. Considering this literature gap, we conducted this review that seeks to systematically synthesize the current evidence available regarding the impact of nurse-coordinated multidisciplinary care on clinical outcomes in patients with HF. A comprehensive search was done using PubMed/Medline, Cochrane Library, and EMBASE from inception till July 2023 for randomized controlled trials (RCTs) comparing nurse-coordinated multidisciplinary care with usual care in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations, and all-cause hospitalizations was extracted, pooled, and analyzed. Forrest plots were generated using the random effects model. A total of 30 RCTs were included in the analysis with a total of 7950 HF patients. Our pooled analysis demonstrated a significant reduction in all-cause mortality in HF patients who received nurse-coordinated multidisciplinary care (RR = 0.80, 95% CI: 0.72-0.88, P = 0.0001). Similarly, there was a significantly lesser risk of HF-related hospitalizations (RR = 0.56, 95% CI: 0.45-0.71, P = 0.00001) and all-cause hospitalizations (RR = 0.78, 95% CI: 0.70-0.87, P = 0.0001) among HF patients with nurse-coordinated multidisciplinary care as compared to the usual care. Nurse-coordinated multidisciplinary care significantly reduces the risk of all-cause mortality, HF-related hospitalizations, and all-cause hospitalizations in HF patients' posthospital discharge.
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Affiliation(s)
- Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Aimen Shafiq
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maheen Zahid
- Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Siwar Dhawadi
- Department of Medicine, Faculty of Medicine Monastir, Mosastir, Tunisia
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
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Mahabaleshwarkar R, Bond A, Burns R, Taylor YJ, McWilliams A, Schooley J, Applegate WB, Little G. Prevalence and Correlates of Uncontrolled Hypertension, Persistently Uncontrolled Hypertension, and Hypertensive Crisis at a Healthcare System. Am J Hypertens 2023; 36:667-676. [PMID: 37639217 DOI: 10.1093/ajh/hpad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Uncontrolled hypertension significantly increases risk of cardiovascular disease and death. This study examined the prevalence of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis and factors associated with these outcomes in a real-world patient cohort. METHODS Electronic medical records from a large healthcare system in North Carolina were used to identify adults with uncontrolled hypertension (last ambulatory blood pressure [BP] measurement ≥140/90); persistently uncontrolled hypertension (≥2 ambulatory BP measurements with all readings ≥140/90); and hypertensive crisis (any BP reading ≥180/120) in 2019. Generalized linear mixed models tested the association between patient and provider characteristics and each outcome. RESULTS The study cohort included 213,836 patients (mean age 63.1 (±14.0) years, 55.5% female, 70.8% white). Of these, 29.7% and 13.1% had uncontrolled hypertension and hypertensive crisis, respectively. Among those experiencing hypertensive crisis, >50% did not have uncontrolled hypertension. Of the 171,061 patients with ≥2 BP measurements, 5.9% had persistently uncontrolled hypertension. The likelihood of uncontrolled hypertension, persistently uncontrolled hypertension, and hypertensive crisis was higher in patients with black race (vs. white), self-pay (vs. private), prior emergency room visit, and no attributed primary care provider. Readings taken in the evening (vs. morning) and at specialty (vs. primary care) practices were more likely to meet thresholds for uncontrolled hypertension and hypertensive crisis. CONCLUSIONS Hypertension control remains a significant challenge in healthcare. Health systems may benefit from segmenting their patient population based on factors such as race, prior healthcare use, and timing of BP measurement to prioritize outreach and intervention.
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Affiliation(s)
| | - Allan Bond
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Ryan Burns
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Yhenneko J Taylor
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - Andrew McWilliams
- Center for Health System Sciences, Atrium Health, Charlotte, North Carolina, USA
| | - John Schooley
- Quality Management, Atrium Health, Charlotte, North Carolina, USA
| | - William B Applegate
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Gary Little
- Medical Affairs, Atrium Health, Charlotte, North Carolina, USA
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Dufour E, Bolduc J, Leclerc-Loiselle J, Charette M, Dufour I, Roy D, Poirier AA, Duhoux A. Examining nursing processes in primary care settings using the Chronic Care Model: an umbrella review. BMC PRIMARY CARE 2023; 24:176. [PMID: 37661248 PMCID: PMC10476383 DOI: 10.1186/s12875-023-02089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND While there is clear evidence that nurses can play a significant role in responding to the needs of populations with chronic conditions, there is a lack of consistency between and within primary care settings in the implementation of nursing processes for chronic disease management. Previous reviews have focused either on a specific model of care, populations with a single health condition, or a specific type of nurses. Since primary care nurses are involved in a wide range of services, a comprehensive perspective of effective nursing processes across primary care settings and chronic health conditions could allow for a better understanding of how to support them in a broader way across the primary care continuum. This systematic overview aims to provide a picture of the nursing processes and their characteristics in chronic disease management as reported in empirical studies, using the Chronic Care Model (CCM) conceptual approach. METHODS We conducted an umbrella review of systematic reviews published between 2005 and 2021 based on the recommendations of the Joanna Briggs Institute. The methodological quality was assessed independently by two reviewers using the AMSTAR 2 tool. RESULTS Twenty-six systematic reviews and meta-analyses were included, covering 394 primary studies. The methodological quality of most reviews was moderate. Self-care support processes show the most consistent positive outcomes across different conditions and primary care settings. Case management and nurse-led care show inconsistent outcomes. Most reviews report on the clinical components of the Chronic Care Model, with little mention of the decision support and clinical information systems components. CONCLUSIONS Placing greater emphasis on decision support and clinical information systems could improve the implementation of nursing processes. While the need for an interdisciplinary approach to primary care is widely promoted, it is important that this approach not be viewed solely from a clinical perspective. The organization of care and resources need to be designed to support contributions from all providers to optimize the full range of services available to patients with chronic conditions. PROSPERO REGISTRATION CRD42021220004.
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Affiliation(s)
- Emilie Dufour
- Faculty of Nursing, Université de Montréal, Montréal, Canada.
| | - Jolianne Bolduc
- École de santé publique, Université de Montréal, Montréal, Canada
| | | | - Martin Charette
- School of Nursing, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dufour
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être, Gouvernement du Québec, Montréal, Canada
| | | | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Canada
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Koleva G, Hristova I, Georgieva D, Yotov Y. Blood pressure reduction in difficult-to-control patients and the effect of a nurse-led program in Bulgaria. JOURNAL OF VASCULAR NURSING 2023; 41:125-131. [PMID: 37684090 DOI: 10.1016/j.jvn.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 04/21/2023] [Accepted: 05/29/2023] [Indexed: 09/10/2023]
Abstract
Hypertension is a major contributor to cardiovascular morbidity and mortality. Although there has been significant improvement in blood pressure (BP) control during the last decades, it is still far from optimal. Several strategies for hypertension management have been proposed, and among all - nurse-led programs seem encouraging. AIM To evaluate the effect of a complex nurse program aiming to reduce BP in patients with uncontrolled hypertension. PATIENTS AND METHODS In a cardiologist's office, a trained nurse included patients with uncontrolled hypertension and newly referred patients with high BP in a program for hypertension management. It consisted of patient education, assessment of quality of life, lifestyle advice, medication improvement and adherence stimulation. All patients were followed for 6 months and their BP, lifestyle indicators, and quality of life measurements were recorded. Statistical analyses included two- and one sample t-tests, chi-square test, correlation and multivariate linear regression. RESULTS Overall, 47 patients, presenting with uncontrolled hypertension and with BP>140/90 mm Hg were included in this research. Their BP was reduced within 6 months by mean 30 /11 mm Hg and after 6 months, from 162/88 to 133/77 mm Hg. The drop of BP values was present at the first month with mean BP 140/82 mm Hg. Control of hypertension improved from 2% to 55% at the 1st month mark and to 79% at the 6th month, p<0.0001. The decrease in SBP was positively correlated to decrease in waist circumference, p = 0.47, p = 0.009. In multivariate linear regression analysis, the difference in BP was significantly related to self-assessment health scoring and marginally significant with renal impairment. CONCLUSIONS The development of a complex nurse-led program, tailored to patients with uncontrolled hypertension, leads to significant positive effect on BP decrease and improves hypertension control in primary care. This may be cost effective and improve BP control in low- to middle-income countries.
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Affiliation(s)
- Greta Koleva
- Ruse University "Angel Kanchev", Department of Health care, Faculty of public health and health care, Bulgaria
| | - Irinka Hristova
- Ruse University "Angel Kanchev", Department of Health care, Faculty of public health and health care, Bulgaria.
| | - Despina Georgieva
- Ruse University "Angel Kanchev", Department of Health care, Faculty of public health and health care, Bulgaria
| | - Yoto Yotov
- First Department of Internal Medicine, Faculty of Medicine, Medical University "Prof. Dr. P. Stoyanov"-Varna, Bulgaria
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Hellgren M, Wennberg P, Hedin K, Jansson S, Nilsson S, Nilsson G, Wändell P, Bengtsson Boström K. Hypertension management in primary health care: a survey in eight regions of Sweden. Scand J Prim Health Care 2023; 41:343-350. [PMID: 37561134 PMCID: PMC10478603 DOI: 10.1080/02813432.2023.2242711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE To explore hypertension management in primary healthcare (PHC). DESIGN Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021. SETTING Seventy-six PHCCs in eight regions of Sweden. MAIN OUTCOME MEASURES Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up. RESULTS The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300-11300) patients. CONCLUSIONS The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.
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Affiliation(s)
- Mikko Hellgren
- University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Katarina Hedin
- Futurum, Jönköping, Region Jönköping County, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Stefan Jansson
- University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Staffan Nilsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Nilsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Kristina Bengtsson Boström
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Kappes M, Espinoza P, Jara V, Hall A. Nurse-led telehealth intervention effectiveness on reducing hypertension: a systematic review. BMC Nurs 2023; 22:19. [PMID: 36650463 PMCID: PMC9843665 DOI: 10.1186/s12912-022-01170-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertension is a public health concern for many countries. The World Health Organization has established a global objective to reduce the prevalence of non-communicable diseases, including hypertension, which is associated with cardiovascular disease. Remote nursing interventions can potentially lessen the burden on the healthcare system and promote a healthier population. This systematic review aims to synthesize available evidence on the effectiveness of nursing-led telehealth interventions in reducing blood pressure in hypertensive patients. METHODS A systematic review was conducted. The search was performed from May to June 2021, in the databases: PubMed, Scopus, Cochrane Library, Web of Science, CINAHL, and ProQuest within 2010-2021 in English, Spanish and Portuguese. Randomized controlled trials and Quasi-experimental studies were considered. This systematic review followed the criteria of the Cochrane Handbook for Systematic Reviews of Interventions, with the support of the PRISMA guidelines and registered in PROSPERO. For critical analysis, the tools of the Joanna Briggs Institute were used. RESULTS Of the 942 articles found, six controlled clinical trials and one quasi-experimental study were selected. Different nurse-led interventions (telehealth devices, remote video consultation, calls and email alerts) have demonstrated a significant decrease in blood pressure (especially systolic blood pressure) in the intervention groups. Nurse-led interventions also effect hypertension awareness, self-efficacy, and self-control. Positive effects on lowering cholesterol, consumption of fruits and vegetables, physical activity and adherence to medication were also described. CONCLUSION Nurse-led interventions delivered remotely have a positive effect in lowering the blood pressure of patients with hypertension. Further research is required to support strategies that will deliver the best continuous, quality, and cost-effective nursing care.
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Affiliation(s)
- Maria Kappes
- grid.442215.40000 0001 2227 4297Faculty of Health Care Sciences, Nursing School, Universidad San Sebastián, Puerto Montt, Chile
| | - Pilar Espinoza
- grid.442215.40000 0001 2227 4297Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
| | - Vanessa Jara
- grid.442215.40000 0001 2227 4297Faculty of Health Care Sciences, Nursing School, Universidad San Sebastián, Santiago, Chile
| | - Amanda Hall
- grid.259029.50000 0004 1936 746XHeath, Medicine, and Society, Minor Population Health, Biology, Lehigh University, Bethlehem, USA
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15
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Kavita K, Thakur J, Ghai S, Narang T, Kaur R. Nurse-led interventions for prevention and control of noncommunicable diseases in low- and middle-income countries: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2023. [DOI: 10.4103/jncd.jncd_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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16
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Home Blood Pressure Self-monitoring plus Self-titration of Antihypertensive Medication for Poorly Controlled Hypertension in Primary Care: the ADAMPA Randomized Clinical Trial. J Gen Intern Med 2023; 38:81-89. [PMID: 36219303 PMCID: PMC9849508 DOI: 10.1007/s11606-022-07791-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 09/06/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure. OBJECTIVE This study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients. DESIGN The ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain. PARTICIPANTS Hypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018. INTERVENTION Participants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration. MAIN MEASURE The primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months. KEY RESULTS Primary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was -2.9 mmHg (95% CI, -5.9 to 0.1, p=0.061), while the AMD in DBP was -1.9 mmHg (95% CI, -3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events. CONCLUSION Self-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events. TRIAL REGISTRATION EudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov , NCT03242785.
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Nopsopon T, Kantagowit P, Chumsri C, Towannang P, Wechpradit A, Aiyasanon N, Phaichan R, Kanjanabuch T, Pongpirul K. Nurse-based educational interventions in patients with peritoneal dialysis: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100102. [PMID: 38745642 PMCID: PMC11080474 DOI: 10.1016/j.ijnsa.2022.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/25/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Peritoneal dialysis (PD) is a major renal replacement therapy modality for patients with end-stage kidney disease (ESKD) worldwide. As poor self-care of PD patients could lead to serious complications, including peritonitis, exit-site infection, technique failure, and death; several nurse-based educational interventions have been introduced. However, these interventions varied and have been supported by small-scale studies so the effectiveness of nurse-based educational interventions on clinical outcomes of PD patients has been inconclusive. Objectives To evaluate the effectiveness of nurse-based education interventions in PD patients. Design A systematic review and meta-analysis of Randomized Controlled Trials (RCTs). Methods We performed a systematic search using PubMed, Embase, and CENTRAL up to December 31, 2021. Selection criteria included Randomized Controlled Trials (RCTs) relevant to nurse-based education interventions in ESKD patients with PD in the English language. The meta-analyses were conducted using a random-effects model to evaluate the summary outcomes of peritonitis, PD-related infection, mortality, transfer to hemodialysis, and quality of life (QoL). Results From 9,816 potential studies, 71 theme-related abstracts were selected for further full-text articles screening against eligibility criteria. As a result, eleven studies (1,506 PD patients in seven countries) were included in our systematic review. Of eleven studies, eight studies (1,363 PD patients in five countries) were included in the meta-analysis. Sleep QoL in the intervention group was statistically significantly higher than control (mean difference = 12.76, 95% confidence intervals 5.26-20.27). There was no difference between intervention and control groups on peritonitis, PD-related infection, HD transfer, and overall QoL. Conclusions Nurse-based educational interventions could help reduce some PD complications, of which only the sleep QoL showed statistically significant improvement. High-quality evidence on the nurse-based educational interventions was limited and more RCTs are needed to provide more robust outcomes. Tweetable abstract Nurse-based educational interventions showed promising sleep quality improvement and potential peritonitis risk reduction among PD patients.
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Affiliation(s)
- Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyawat Kantagowit
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chitsanucha Chumsri
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyaporn Towannang
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Nipa Aiyasanon
- Medical and Psychiatric Nursing Division, Department of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ruchdaporn Phaichan
- Respiratory Intensive Critical Care Unit, Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand
| | - Talerngsak Kanjanabuch
- Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Bumrungrad International Hospital, Bangkok, Thailand
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Bian W, Wang Z, Wan J, Zhang F, Wu X, Li X, Luo Y. Exploring challenges to nutrition intervention adherence using COM-B model among patients with wet age-related macular degeneration: a qualitative study. BMJ Open 2022; 12:e064892. [PMID: 36446464 PMCID: PMC9710364 DOI: 10.1136/bmjopen-2022-064892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore challenges to nutrition intervention adherence using the Capability, Opportunity and Motivation-Behaviour (COM-B) model among wet age-related macular degeneration (AMD) patients. These factors should be considered in the development of potential support and intervention programmes to address these problems. DESIGN A qualitative study was conducted with one-to-one and face-to-face interviews with wet AMD patients using a semi-structured question guide. Data were analysed based on COM-B model: capability (physical and psychological), opportunity (physical and social) and motivation (reflective and automatic). SETTING Southwest Hospital of Chongqing Province in China. PARTICIPANTS A convenient and purposive sample of 24 wet AMD patients were recruited. RESULTS The themes and subthemes were identified: psychological capability: (1) insufficient knowledge of nutrition; (2) misconceptions about the disease and treatment; (3) knowledge conflict; physical capability: (1) physical restriction; (2) limited access to nutrition knowledge; physical opportunity: (1) communication between providers and patients; (2) health insurance and extra charges; (3) food environment; social opportunity: (1) stigma of disease; (2) family influence; reflective motivation: (1) self-efficacy; (2) attitude; (3) outcome expectancies; (4) lack of professional support; automatic motivation: (1) difficulties in changing eating habits; (2) mindset. CONCLUSION Medical staff should pay much attention to the process of patients' nutrition intervention. In addition, it is also necessary to develop professional and internet-based intervention to modify the dietary behaviour and improve the management skills of the patients.
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Affiliation(s)
- Wei Bian
- School of Nursing, Third Military Medical University/Army Medical University, Chongqing, China
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Zonghua Wang
- School of Nursing, Third Military Medical University/Army Medical University, Chongqing, China
| | - Junli Wan
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Feng Zhang
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Xuemei Wu
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Xin Li
- Southwest Eye Hospital, Third Military Medical University/Army Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, Third Military Medical University/Army Medical University, Chongqing, China
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19
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Khoong EC, Commodore-Mensah Y, Lyles CR, Fontil V. Use of Self-Measured Blood Pressure Monitoring to Improve Hypertension Equity. Curr Hypertens Rep 2022; 24:599-613. [PMID: 36001268 PMCID: PMC9399977 DOI: 10.1007/s11906-022-01218-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To evaluate how self-measured blood pressure (SMBP) monitoring interventions impact hypertension equity. RECENT FINDINGS While a growing number of studies have recruited participants from safety-net settings, racial/ethnic minority groups, rural areas, or lower socio-economic backgrounds, few have reported on clinical outcomes with many choosing to evaluate only patient-reported outcomes (e.g., satisfaction, engagement). The studies with clinical outcomes demonstrate that SMBP monitoring (a) can be successfully adopted by historically excluded patient populations and safety-net settings and (b) improves outcomes when paired with clinical support. There are few studies that explicitly evaluate how SMBP monitoring impacts hypertension disparities and among rural, low-income, and some racial/ethnic minority populations. Researchers need to design SMBP monitoring studies that include disparity reduction outcomes and recruit from broader populations that experience worse hypertension outcomes. In addition to assessing effectiveness, studies must also evaluate how to mitigate multi-level barriers to real-world implementation of SMBP monitoring programs.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine at Zuckerberg, Department of Medicine, San Francisco General Hospital, UCSF, Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, USA.
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Courtney R Lyles
- Division of General Internal Medicine at Zuckerberg, Department of Medicine, San Francisco General Hospital, UCSF, Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Valy Fontil
- Division of General Internal Medicine at Zuckerberg, Department of Medicine, San Francisco General Hospital, UCSF, Building 10, Ward 13, 1001 Potrero Avenue, San Francisco, CA, 94110, USA
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, USA
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20
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Montayre J, Liu MF, Calma KRB, Zhao IY, Ho MH. Nurse visit utilization and blood pressure control: A multi-cohort study in New Zealand. Public Health Nurs 2022; 39:1181-1187. [PMID: 35594576 DOI: 10.1111/phn.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to retrospectively examine the contribution of nurses to population health outcomes with reference to nurse visits and blood pressure measurement in primary health settings. DESIGN A retrospective study was conducted using New Zealand Health Survey (NZHS) from 2012 to 2017. SAMPLE Adult population who are 18 years old and over living in New Zealand. MEASUREMENTS Age, gender, and ethnicity, the service utilization of primary health care nurse visit and blood pressure measurement were extracted from the NZHS (2012-2017) to compare with the service utilization of primary health care nurses by different demographic groups. RESULTS Females who have treated hypertension shows higher utilization of nurse visit than males. From 2015 to 2017, the participants in this cohort have visited a primary health care nurse at least more than once within a year. With blood pressure control, the overall pooled results show the impact of visiting primary health nurses on systolic and diastolic blood pressure control. CONCLUSION Our study at a national scale, demonstrated the impact of nurse's contribution to population health outcomes among people living with hypertension in New Zealand. Nurses are key to improving population health outcomes and to achieve universal health coverage.
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Affiliation(s)
- Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Megan F Liu
- School of Gerontology Health Management, Taipei Medical University, Taipei, Taiwan
| | - Kaara Ray B Calma
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.,School of Nursing and Midwifery, Deakin University, Victoria, Geelong, Australia
| | - Ivy Yan Zhao
- WHO Collaborating Centre for Community Health Services, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Mu-Hsing Ho
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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21
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Sun Y, Mu J, Wang DW, Ouyang N, Xing L, Guo X, Zhao C, Ren G, Ye N, Zhou Y, Wang J, Li Z, Sun G, Yang R, Chen CS, He J. A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial. Lancet 2022; 399:1964-1975. [PMID: 35500594 DOI: 10.1016/s0140-6736(22)00325-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The prevalence of uncontrolled hypertension is high and increasing in low-income and middle-income countries. We tested the effectiveness of a multifaceted intervention for blood pressure control in rural China led by village doctors (community health workers on the front line of primary health care). METHODS In this open, cluster randomised trial (China Rural Hypertension Control Project), 326 villages that had a regular village doctor and participated in the China New Rural Cooperative Medical Scheme were randomly assigned (1:1) to either village doctor-led multifaceted intervention or enhanced usual care (control), with stratification by provinces, counties, and townships. We recruited individuals aged 40 years or older with an untreated blood pressure of 140/90 mm Hg or higher (≥130/80 mm Hg among those with a history of cardiovascular disease, diabetes, or chronic kidney disease) or a treated blood pressure of 130/80 mm Hg or higher. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure monitoring, lifestyle changes, and medication adherence. The primary outcome (reported here) was the proportion of patients with a blood pressure of less than 130/80 mm Hg at 18 months. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03527719, and is ongoing. FINDINGS Between May 8 and November 28, 2018, we enrolled 33 995 individuals from 163 intervention and 163 control villages. At 18 months, 8865 (57·0%) of 15 414 patients in the intervention group and 2895 (19·9%) of 14 500 patients in the control group had a blood pressure of less than 130/80 mm Hg, with a group difference of 37·0% (95% CI 34·9 to 39·1%; p<0·0001). Mean systolic blood pressure decreased by -26·3 mm Hg (95% CI -27·1 to -25·4) from baseline to 18 months in the intervention group and by -11·8 mm Hg (-12·6 to -11·0) in the control group, with a group difference of -14·5 mm Hg (95% CI -15·7 to -13·3 mm Hg; p<0·0001). Mean diastolic blood pressure decreased by -14·6 mm Hg (-15·1 to -14·2) from baseline to 18 months in the intervention group and by -7·5 mm Hg (-7·9 to -7·2) in the control group, with a group difference of -7·1 mm Hg (-7·7 to -6·5 mm Hg; p<0·0001). No treatment-related serious adverse events were reported in either group. INTERPRETATION Compared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. FUNDING Ministry of Science and Technology of China.
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Affiliation(s)
- Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China.
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Nanxiang Ouyang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Liying Xing
- Department of Chronic Disease Control, Disease Control and Prevention Centre of Liaoning Province, Shenyang, China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | | | - Ning Ye
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Ying Zhou
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Jun Wang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Zhao Li
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guozhe Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | | | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA.
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22
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Kanukula R, Dhurjati R, Vidyasagar K, Rehana N, Talari A, Salam A, Rodgers A, Page MJ. Quality of systematic reviews supporting the 2017 ACC/AHA and 2018 ESC/ESH guidelines for the management of hypertension. BMJ Evid Based Med 2022; 27:79-86. [PMID: 34088714 DOI: 10.1136/bmjebm-2021-111675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the methodological and reporting quality of systematic reviews (SRs) that informed recommendations in the recent American and European hypertension guidelines. DESIGN AND SETTINGS Meta-epidemiological study. We identified SRs that were cited for class I recommendations based on Level of Evidence-A in the 2017 American College of Cardiology/American Heart Association (ACC/AHA) and the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guidelines. MAIN OUTCOME MEASURES Methodological and reporting quality of the SRs was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) checklist and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, respectively. RESULTS A total of 40 SRs was included in the analysis (28 from 2017 ACC/AHA; 22 from 2018 ESC/ESH and 10 were included in both). Based on the AMSTAR-2 assessment, only 7.5% SRs were found to be of high methodological quality, 47.5% were of moderate, each 22.5% were of low and critically low quality. Based on the PRISMA checklist assessment, a mean of 24 items (SD (2.76) were reported appropriately, and only five SRs reported all 27 items appropriately. CONCLUSION Methodological and reporting quality of SRs were found to vary considerably. Lack of information on the funding source of included studies, use of a protocol, integration of risk of bias assessments while interpreting findings and reporting of excluded studies were major methodological deficiencies.
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Affiliation(s)
- Raju Kanukula
- Research Methodology Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiovascular, The George Institute for Global Health, Hyderabad, India
| | - Rupasvi Dhurjati
- Cardiovascular, The George Institute for Global Health, Hyderabad, India
| | - Kota Vidyasagar
- Cardiovascular, The George Institute for Global Health, Hyderabad, India
| | - Nusrath Rehana
- Cardiovascular, The George Institute for Global Health, Hyderabad, India
| | - Arun Talari
- Cardiovascular, The George Institute for Global Health, Hyderabad, India
| | - Abdul Salam
- Cardiovascular, The George Institute for Global Health, Hyderabad, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Rodgers
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Cardiovascular Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Matthew J Page
- Research Methodology Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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23
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Wang MC, Dolan B, Freed BH, Vega L, Markoski N, Wainright AE, Kane B, Seegmiller LE, Harrington K, Lewis AA, Shah SJ, Yancy CW, Neeland IJ, Ning H, Lloyd-Jones DM, Khan SS. Rationale and Design of a Pharmacist-led Intervention for the Risk-Based Prevention of Heart Failure: The FIT-HF Pilot Study. Front Cardiovasc Med 2021; 8:785109. [PMID: 34912869 PMCID: PMC8667267 DOI: 10.3389/fcvm.2021.785109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Given rising morbidity, mortality, and costs due to heart failure (HF), new approaches for prevention are needed. A quantitative risk-based strategy, in line with established guidelines for atherosclerotic cardiovascular disease prevention, may efficiently select patients most likely to benefit from intensification of preventive care, but a risk-based strategy has not yet been applied to HF prevention. Methods and Results: The Feasibility of the Implementation of Tools for Heart Failure Risk Prediction (FIT-HF) pilot study will enroll 100 participants free of cardiovascular disease who receive primary care at a single integrated health system and have a 10-year predicted risk of HF of ≥5% based on the previously validated Pooled Cohort equations to Prevent Heart Failure. All participants will complete a health and lifestyle questionnaire and undergo cardiac biomarker (B-type natriuretic peptide [BNP] and high-sensitivity cardiac troponin I [hs-cTn]) and echocardiography screening at baseline and 1-year follow-up. Participants will be randomized 1:1 to either a pharmacist-led intervention or usual care for 1 year. Participants in the intervention arm will undergo consultation with a pharmacist operating under a collaborative practice agreement with a supervising cardiologist. The pharmacist will perform lifestyle counseling and recommend initiation or intensification of therapies to optimize risk factor (hypertension, diabetes, and cholesterol) management according to the most recent clinical practice guidelines. The primary outcome is change in BNP at 1-year, and secondary and exploratory outcomes include changes in hs-cTn, risk factor levels, and cardiac mechanics at follow-up. Feasibility will be examined by monitoring retention rates. Conclusions: The FIT-HF pilot study will offer insight into the feasibility of a strategy of quantitative risk-based enrollment into a pharmacist-led prevention program to reduce heart failure risk. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT04684264.
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Affiliation(s)
- Michael C Wang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bridget Dolan
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Benjamin H Freed
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lourdes Vega
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Nikola Markoski
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Amy E Wainright
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, United States
| | - Bonnie Kane
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Laura E Seegmiller
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katharine Harrington
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alana A Lewis
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sanjiv J Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ian J Neeland
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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24
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Santschi V, Wuerzner G, Pais B, Chiolero A, Schaller P, Cloutier L, Paradis G, Burnier M. Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial. Front Cardiovasc Med 2021; 8:760662. [PMID: 34760950 PMCID: PMC8572997 DOI: 10.3389/fcvm.2021.760662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: We evaluated the effect on long term blood pressure (BP) of an interprofessional team-based care (TBC) intervention, involving nurses, pharmacists, and physicians, compared to usual care. Methods: We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC or usual care (UC). In the TBC group, nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle, support medication adherence, and provide health education for 6 months. After each visit, they wrote a report to the physician who could adjust antihypertensive therapy. The outcome was the intention-to-treat difference in mean daytime ambulatory blood pressure measurement (ABPM) and control (<135/85 mmHg) at 6 and 12 months. Results: Eighty-nine patients (60 men/29 women; mean (SD) age: 61(12) year) were randomized to TBC (n = 43) or UC (n = 46). At baseline, mean (SD) BP was 144(10)/90(8) mmHg and 147(12)/87(11) mmHg in the TBC and UC groups. At 6 months, the between-groups difference in daytime systolic ABPM was−3 mmHg [95% confidence interval (CI):−10 to +4; p = 0.45]; at 12 months, this difference was−7 mmHg [95% CI:−13 to−2; p = 0.01]. At 6 months, the between-groups difference in daytime diastolic ABPM was +2 mmHg [95% CI:−1 to +6; p = 0.20]; at 12 months, this difference was−2 mmHg [95% CI:−5 to +2; 0.42]. Upon adjustment for baseline covariates including baseline BP, the between-groups differences at 6 and 12 months were maintained. At 6 months, there was no difference in BP control. At 12 months, the TBC group tended to have a better control in systolic BP (p = 0.07) but not in diastolic BP (p = 0.33). Conclusion: While there was not significant effect on BP at 6 months of follow-up, the TBC intervention can help decrease long-term systolic BP among uncontrolled hypertensive patients.
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Affiliation(s)
- Valérie Santschi
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Bruno Pais
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Arnaud Chiolero
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Gilles Paradis
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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25
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Karimzadeh A, Leupold F, Thielmann A, Amarell N, Klidis K, Schroeder V, Kersting C, Ose C, Joeckel KH, Weltermann B. Optimizing blood pressure control by an Information Communication Technology-supported case management (PIA study): study protocol for a cluster-randomized controlled trial of a delegation model for general practices. Trials 2021; 22:738. [PMID: 34696791 PMCID: PMC8543417 DOI: 10.1186/s13063-021-05660-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background Longitudinal hypertension control prevents heart attacks, strokes, and other cardiovascular diseases. However, 49% of patients in German family medicine practices do not reach blood pressure (BP) targets (< 140/90 mmHg). Drawing on successful international approaches, the PIA study introduces the PIA information and communication technology system (PIA-ICT) for hypertension management in primary care. The PIA-ICT comprises the PIA-App for patients and the PIA practice management center for practices. Case management includes electronic communication with patients, recall, and stepwise medication adjustments following guidelines. The system supports a physician-supervised delegation model to practice assistants. General practitioners are qualified by eLearning. Patients learn how to obtain reliable BP readings, which they communicate to the practice using the PIA-App. Methods The effectiveness of the PIA-Intervention is evaluated in a cluster-randomized study with 60 practices, 120 practice assistants, and 1020 patients. Patients in the intervention group receive the PIA-Intervention; the control group receives usual care. The primary outcome is the BP control rate (BP < 140/90 mmHg) after 12 months. Using a mixed methods approach, secondary outcomes address the acceptance on behalf of physicians, practice assistants, and patients. This includes an evaluation of the delegation model. Discussion It is hypothesized that the PIA-Intervention will improve the quality of BP care. Perspectively, it may constitute an important health service model for primary care in Germany. Trial registration German Clinical Trials Register DRKS00012680. Registered on May 10, 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05660-4.
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Affiliation(s)
- Arian Karimzadeh
- Institute of Family Medicine and General Practice, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Frauke Leupold
- Institute of Family Medicine and General Practice, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anika Thielmann
- Institute of Family Medicine and General Practice, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nicola Amarell
- Institute of Family Medicine and General Practice, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Kerstin Klidis
- Institute of Family Medicine and General Practice, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Verena Schroeder
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christine Kersting
- Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Claudia Ose
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Karl-Heinz Joeckel
- Center for Clinical Trials, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.,Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Birgitta Weltermann
- Institute of Family Medicine and General Practice, Medical Faculty of the University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Institute for General Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
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26
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Burnier M, Prejbisz A, Weber T, Azizi M, Cunha V, Versmissen J, Gupta P, Vaclavik J, Januszewicz A, Persu A, Kreutz R. Hypertension healthcare professional beliefs and behaviour regarding patient medication adherence: a survey conducted among European Society of Hypertension Centres of Excellence. Blood Press 2021; 30:282-290. [PMID: 34392741 DOI: 10.1080/08037051.2021.1963209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Little is known on the beliefs, perceptions and practices of hypertension specialists in addressing non-adherence to therapy. Therefore, a survey was undertaken amongst healthcare professionals (HCPs) managing hypertension in the European Society of Hypertension (ESH) Centres of Excellence. MATERIALS AND METHODS Cross-sectional data were obtained between December 2020 and April 2021 using an online anonymous structured questionnaire including 26 questions/136 items, that was sent to all ESH Excellence centres. RESULTS Overall 67 from 187 centres (37.3%) responded and 200 HCPs from 30 countries answered the questionnaire. Participants (60% men) were mainly physicians (91%) and nurses (8%) from University hospitals (77%). Among physicians, 83% had >10 years professional experience. Average time dedicated to discuss medications was 1-5 min in 48% and 6-10 min in 29% of cases. Interviews with patients about adherence were the most frequently used assessment method. Chemical detection of medications in urine was available in 36% of centres. One third of physicians involved their patients regularly in treatment decisions. The most frequent methods to improve adherence included simplification of medication therapy, more frequent visits, and home blood pressure monitoring. CONCLUSIONS The level of implementation of tools to detect and improve adherence in hypertension management by HCPs in ESH excellence centres is low. Structured educational activities focussing on adherence management and access to the newest objective measures to detect non-adherence might improve these deficits.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Michel Azizi
- INSERM, CIC1418, Université de Paris, Paris, France.,Hypertension Department and DMU CARTE, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Jorie Versmissen
- Departments of Internal Medicine and Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Pankaj Gupta
- The Department of Chemical Pathology and Metabolic Diseases, Leicester Royal Infirmary, Leicester, UK
| | - Jan Vaclavik
- Department of Internal Medicine and Cardiology, Ostrava University Hospital, Ostrava, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Humboldt-Universität zu Berlin, Berlin, Germany
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Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change. BMC Public Health 2021; 21:1524. [PMID: 34372808 PMCID: PMC8351340 DOI: 10.1186/s12889-021-11548-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nepal has a high prevalence of hypertension which is a major risk factor for cardiovascular diseases globally. It is inadequately controlled even after its diagnosis despite the availability of effective treatment of hypertension. There is a need for an in-depth understanding of the barriers and facilitators using theory to inform interventions to improve the control of hypertension. This formative study was conducted to address this gap by exploring the perceived facilitators and barriers to treatment and control of hypertension in Nepal. Methods We conducted in-depth interviews (IDIs) among hypertensive patients, their family members, healthcare providers and key informants at primary (health posts and primary health care center) and tertiary level (Kathmandu Medical College) facilities in Kathmandu, Nepal. Additionally, data were collected using focus group discussions (FGDs) with hypertensive patients. Recordings of IDIs and FGDs were transcribed, coded both inductively and deductively, and subthemes generated. The emerging subthemes were mapped to the Capability, Opportunity, and Motivation-Behaviour (COM-B) model using a deductive approach. Results Major uncovered themes as capability barriers were misconceptions about hypertension, its treatment and difficulties in modifying behaviour. Faith in alternative medicine and fear of the consequences of established treatment were identified as motivation barriers. A lack of communication between patients and providers, stigma related to hypertension and fear of its disclosure, and socio-cultural factors shaping health behaviour were identified as opportunity barriers in the COM-B model. The perceived threat of the disease, a reflective motivator, was a facilitator in adhering to treatment. Conclusions This formative study, using the COM-B model of behaviour change identified several known and unknown barriers and facilitators that influence poor control of blood pressure among people diagnosed with hypertension in Kathmandu, Nepal. These findings need to be considered when developing targeted interventions to improve treatment adherence and blood pressure control of hypertensive patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11548-4.
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Choi WS, Kim NS, Kim AY, Woo HS. Nurse-Coordinated Blood Pressure Telemonitoring for Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6892. [PMID: 34199019 PMCID: PMC8297065 DOI: 10.3390/ijerph18136892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has put hypertensive patients in densely populated cities at increased risk. Nurse-coordinated home blood pressure telemonitoring (NC-HBPT) may help address this. We screened studies published in English on three databases, from their inception to 30 November 2020. The effects of NC-HBPT were compared with in-person treatment. Outcomes included changes in blood pressure (BP) following the intervention and rate of BP target achievements before and during COVID-19. Of the 1916 articles identified, 27 comparisons were included in this review. In the intervention group, reductions of 5.731 mmHg (95% confidence interval: 4.120-7.341; p < 0.001) in systolic blood pressure (SBP) and 2.342 mmHg (1.482-3.202; p < 0.001) in diastolic blood pressure (DBP) were identified. The rate of target BP achievement was significant in the intervention group (risk ratio, RR = 1.261, 1.154-1.378; p < 0.001). The effects of intervention over time showed an SBP reduction of 3.000 mmHg (-5.999-11.999) before 2000 and 8.755 mmHg (5.177-12.334) in 2020. DBP reduced by 2.000 mmHg (-2.724-6.724) before 2000 and by 3.529 mmHg (1.221-5.838) in 2020. Analysis of the target BP ratio before 2010 (RR = 1.101, 1.013-1.198) and in 2020 (RR = 1.906, 1.462-2.487) suggested improved BP control during the pandemic. NC-HBPT more significantly improves office blood pressure than UC among urban hypertensive patients.
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Affiliation(s)
- Woo-Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea; (A.-Y.K.); (H.-S.W.)
- Keyu Internal Medicine Clinic, Daejeon 35250, Korea
| | - Nam-Suk Kim
- Public Health and Welfare Bureau, Daejeon City Hall, Daejeon 35242, Korea;
| | - Ah-Young Kim
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea; (A.-Y.K.); (H.-S.W.)
| | - Hyung-Soo Woo
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea; (A.-Y.K.); (H.-S.W.)
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Michael S, MacDonald K. Improving rates of metabolic monitoring on an inpatient psychiatric ward. BMJ Open Qual 2021; 9:bmjoq-2019-000748. [PMID: 32699081 PMCID: PMC7375397 DOI: 10.1136/bmjoq-2019-000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022] Open
Abstract
Objectives Cardiovascular disease is the leading cause of premature death in patients with mental illness. Metabolic syndrome is a cluster of co-occurring cardiovascular risk factors, seen in high frequency in severe mental illness. Despite ease of diagnosis, monitoring is often poor across psychiatric populations. This report details a quality improvement initiative undertaken on an inpatient psychiatric ward to improve rates of metabolic monitoring. Methods Four key interventions were developed: (1) A nurse-led intervention, where nurses were upskilled in performing metabolic monitoring, (2) Education was provided to all staff, (3) Introduction of a suite of interventions to improve metabolic risk and (4) Ongoing consumer involvement. A pre–post intervention study design was used to measure effectiveness, with an audit of metabolic monitoring rates performed 12 months after the intervention began. Results Rates of weight and height monitoring both increased from 46.0% to 69.5% (p=0.0185) and body mass index (BMI) recordings increased from 33% to 63% (p=0.0031). Rates of waist circumference monitoring increased from 44.2% to 65.2% (p=0.0498). Blood pressure (BP) measurements increased from 88.5% to 100% (p=0.0188). Lipid monitoring rates improved from 23% to 69.5% (p=0.001). Rates of glucose monitoring increased from 74% to 82.5% (p=0.8256), although this was not statistically significant. Conclusions We found that metabolic monitoring improved following these simple interventions, with a statistically significant increase in measurement rates of weight, BP, height, lipids, BMI and waist circumference (p<0.05). Overall monitoring of glucose also improved, although not to significant levels. The intervention was acceptable to both patients and staff.
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Affiliation(s)
- Sarah Michael
- Mental Health Service, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia .,School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kirsty MacDonald
- Justice Health and Forensic Mental Health Network, Matraville, New South Wales, Australia
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Abstract
Recently published national data demonstrate inadequate and worsening control of high blood pressure (HBP) in the United States, outcomes that likely have been made even worse by the coronavirus disease 2019 (COVID-19) pandemic. This major public health crisis exposes shortcomings of the US health care delivery system and creates an urgent opportunity to reduce mortality, major cardiovascular events, and costs for 115 million Americans. Ending this crisis will require a more coherent and systemic change to traditional patterns of care. The authors present an evidence-based Blueprint for Change for comprehensive health delivery system redesign based on current national clinical practice guidelines and quality measures. This innovative model includes a systems-based approach to ensuring proper BP measurement, assessment of cardiovascular risk, effective patient-centered team-based care, addressing social determinants of health, and shared decision-making. The authors also propose building on current national quality improvement initiatives designed to better control HBP.
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31
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Kassavou A, Mirzaei V, Shpendi S, Brimicombe J, Chauhan J, Bhattacharya D, Naughton F, Hardeman W, Eborall H, Van Emmenis M, De Simoni A, Takhar A, Gupta P, Patel P, Mascolo C, Prevost AT, Morris S, Griffin S, McManus RJ, Mant J, Sutton S. The feasibility of the PAM intervention to support treatment-adherence in people with hypertension in primary care: a randomised clinical controlled trial. Sci Rep 2021; 11:8897. [PMID: 33903656 PMCID: PMC8076273 DOI: 10.1038/s41598-021-88170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 04/06/2021] [Indexed: 11/22/2022] Open
Abstract
The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3–36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69–12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64–1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42–5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention. Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989.
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Affiliation(s)
- Aikaterini Kassavou
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK.
| | - Venus Mirzaei
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Sonia Shpendi
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Jagmohan Chauhan
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK.,School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | | | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Helen Eborall
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Miranda Van Emmenis
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Anna De Simoni
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Amrit Takhar
- Cambridgeshire and Peterborough Clinical Commissioning Group, Cambridge, UK
| | - Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Cecilia Mascolo
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Andrew Toby Prevost
- Nightingale-Saunders Clinical Trials and Epidemiology Unit, King's College London, London, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
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Treciokiene I, Postma M, Nguyen T, Fens T, Petkevicius J, Kubilius R, Gulbinovic J, Taxis K. Healthcare professional-led interventions on lifestyle modifications for hypertensive patients - a systematic review and meta-analysis. BMC FAMILY PRACTICE 2021; 22:63. [PMID: 33820547 PMCID: PMC8022420 DOI: 10.1186/s12875-021-01421-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 03/23/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND About 0.9 billion people in the world have hypertension. The mortality due to hypertension increased dramatically over the last decades. Healthcare professionals should support patients with hypertension to modify their lifestyle to decrease blood pressure, but an overview of effective lifestyle interventions is lacking. The aim of this study was to determine whether healthcare professional-led interventions on lifestyle modifications are effective in lowering blood pressure in patients with hypertension. METHODS A systematic literature review following the PRISMA guidelines was conducted. PubMed, EMBASE and CINAHL databases were searched for randomized control trials (RCTs) of interventions on lifestyle modifications of hypertensive patients which were performed by healthcare professionals (physician, nurse, pharmacist) and which reported blood pressure measurements. Papers were reviewed by two reviewers and analysed using Cochrane software Revman 5.4. In a meta-analysis difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and the percentage of patients with controlled blood pressure (BP) was analysed. RESULTS In total, 34 clinical trials reporting on 22,419 patients (mean age 58.4 years, 49.14% female, 69.9% used antihypertensive medications) were included. The mean difference SBP was - 4.41 mmHg (95% CI, - 5.52to - 3.30) and the mean difference DBP was - 1.66 mmHg (95% CI - 2.44 to - 0.88) in favor of the intervention group vs usual care. Fifty-six percent of patients achieved BP control in the intervention group vs 44% in usual care, OR = 1.87 (95% CI, 1.51 to 2.31). CONCLUSION Healthcare professional-led interventions were effective. Patients achieved almost 5 mmHg decrease of SBP and more patients achieved BP control. The results suggest that efforts are needed for widespread implementation.
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Affiliation(s)
- Indre Treciokiene
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands.
- Pharmacy Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Maarten Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, Netherlands
| | - Thang Nguyen
- Pharmacology & Clinical Pharmacy Department, Can Tho University of Medicine and Pharmacy, Can Tho City, Vietnam
| | - Tanja Fens
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands
| | | | | | - Jolanta Gulbinovic
- Pharmacy Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Katja Taxis
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Groningen, Netherlands
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Parra DI, Guevara SLR, Rojas LZ. 'Teaching: individual' to improve adherence in hypertension and type 2 diabetes. Br J Community Nurs 2021; 26:84-91. [PMID: 33539242 DOI: 10.12968/bjcn.2021.26.2.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Educational interventions with a multifaceted approach have proven effective to improve adherence to therapeutic regimens in people with chronic diseases. The present study aimed to evaluate the efficacy of a nursing intervention involving individual teaching compared with usual care to improve adherence with therapeutic regimens in people with hypertension and/or type-2 diabetes mellitus (T2DM). This was a parallel randomised two-arm clinical trial in 200 patients from a primary care programme. After 6 months of follow-up, there was a significant improvement in treatment adherence with a score of 0.87 (95% CI 0.30 to 1.44) on a 13 point scale, and an average reduction in systolic blood pressure (SBP) of 3.79 mmHg (95% CI: -6.85 to -0.73) in the intervention group, but not in glycated haemoglobin (HbA1c) levels (-0.16% 95% CI: -0.41 to 0.09). The individual teaching intervention was effective in improving therapeutic adherence and improving blood pressure values among the participants from the primary care programme.
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Affiliation(s)
- Dora Inés Parra
- PhD student, Program in Clinical and Community Nursing, Universitat de València; Professor, School of Nursing, Universidad Industrial de Santander (UIS), Colombia
| | - Sandra Lucrecia Romero Guevara
- PhD student, Program in Clinical and Community Nursing, Universitat de València; Professor, School of Nursing, Universidad Industrial de Santander (UIS), Colombia
| | - Lyda Z Rojas
- PhD in Methodology of Biomedical Research and Public Health and Professor, School of Nursing, Universidad Industrial de Santander, Colombia
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Rubin S, Boulestreau R, Couffinhal T, Combe C, Girerd X. [Impaired hypertension control in France: What the nephrologist needs to know]. Nephrol Ther 2020; 16:347-352. [PMID: 33069630 DOI: 10.1016/j.nephro.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 01/13/2023]
Abstract
In France, 1 adult out of 3 is affected by hypertension and only 1 hypertensive out of 4 achieves blood pressure targets (<140/90mmHg). This proportion is significantly better in similar countries (e.g. England, Germany, the USA). Nephrologists are particularly concerned since although more than 90 % of Chronic Kidney Disease (CKD) stages 3 and 4 patients are hypertensive, the CKD-REIN cohort shows that in France more than 1 out of 2 patients with CKD remains with a blood pressure above 140/90mmHg. This report, based on the latest French studies and surveys, raises an important warning about the situation in France, discusses the main reasons for these results and offers some suggestions for improvement. Otherwise we risk a dramatic increase in the incidence of myocardial infarction, stroke, dependency and dementia in the coming years.
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Affiliation(s)
- Sébastien Rubin
- Service de néphrologie, transplantation rénale, dialyse et aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Unité Inserm U1034, university Bordeaux, Bordeaux, France.
| | - Romain Boulestreau
- Service de cardiologie et hypertension artérielle, hôpital de Pau, 4, boulevard Hauterive, 64064 Pau, France
| | - Thierry Couffinhal
- Unité Inserm U1034, university Bordeaux, Bordeaux, France; Service de cardiologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - Christian Combe
- Service de néphrologie, transplantation rénale, dialyse et aphérèses, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Unité Inserm, U1026 BioTis, university Bordeaux, Bordeaux, France
| | - Xavier Girerd
- Fondation de recherche sur l'hypertension artérielle, 12, rue des Colonnes-du-Trône, 75012 Paris, France
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Son YJ, Choi J, Lee HJ. Effectiveness of Nurse-Led Heart Failure Self-Care Education on Health Outcomes of Heart Failure Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186559. [PMID: 32916907 PMCID: PMC7560014 DOI: 10.3390/ijerph17186559] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
Poor self-care behaviors can lead to an increase in the risk of adverse health outcomes among patients with heart failure. Although a number of studies have investigated the effectiveness of nurse-led self-care education, the evidence regarding the effects of nurse-led intervention in heart failure remains uncertain. This study aimed to evaluate evidence on the effectiveness of nurse-led heart failure self-care education on health outcomes in patients with heart failure. To identify studies testing nurse-led education designed to improve self-care among heart failure patients, comprehensive search methods were used between January 2000 and October 2019 to systematically search six electronic databases: PubMed, CINAHL, Embase, Cochrane library, Web of Science, and SCOPUS. All the eligible study data elements were independently assessed and analyzed using random-effects meta-analysis methods. Of 612 studies, eight articles were eligible for this study. Nurse-led heart failure self-care education significantly reduced the risk of all-cause readmission (risk ratio (RR) = 0.75, 95% confidence interval (CI) = 0.66–0.85), heart failure specific readmission (RR = 0.60, 95% CI = 0.42–0.85), and all-cause mortality or readmission (RR = 0.71, 95% CI = 0.61–0.82). However, nurse-led heart failure self-care education was not associated with improvements in the quality of life and heart failure knowledge. Studies on the effectiveness of nurse-led heart failure self-care education mostly report only the positive effects on patients’ health outcomes, whereas evidence of the effectiveness of the nurse-led approach is still limited. Therefore, high quality randomized controlled trials with detailed and explicit descriptions on the components of the interventions are needed.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul 06974, Korea;
| | - JiYeon Choi
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03722, Korea;
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, Korea
- Correspondence: ; Tel.: +82-51-629-2687
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Lee HJ, Lee M, Ha JH, Lee Y, Yun J. Effects of healthcare interventions on psychosocial factors of patients with multimorbidity: A systematic review and meta-analysis. Arch Gerontol Geriatr 2020; 91:104241. [PMID: 32882587 DOI: 10.1016/j.archger.2020.104241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/04/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE A systematic review and meta-analysis was conducted to assess the types of healthcare intervention programs offered to patients with multimorbidity and their effects on key psychosocial factors. METHODS For this systematic review and meta-analysis, we searched databases like Cochrane Library, PubMed, Embase, CINAHL RISS, KISS, etc. for studies published between January 1, 2009, and April 30, 2019. In total, 8,248 studies in English or Korean were reviewed. We included only randomized controlled trials or quasi-experimental studies that applied healthcare interventions and had major effects on the psychosocial factors in adult patients with multimorbidity. Methodological quality was assessed using Cochrane collaboration risk of bias tool. Meta-analysis was performed using the Review Manager 5.3 version to estimate the effect size. RESULTS We identified six randomized controlled trials and 1446 subjects were enrolled. The results reveal that healthcare interventions have an effect on self-rated health (SMD = 0.53 95 % CI: 0.26, 0.79, p < .001), reducing anxiety (SMD = -0.19 95 % CI: -0.36, -0.01, p = .030) and depression (SMD = -0.27 95 % CI: -0.44, -0.10, p = .002), and improving self-efficacy (SMD = 0.21 95 % CI: 0.06, 0.35, p = .005) for patients with multimorbidity. However, there was no significant effect on quality of life. CONCLUSION Healthcare interventions had significant positive effects on self-rated health, anxiety, depression, and self-efficacy of patients with multimorbidity. These results are expected to serve as basic data for the development of a community-based integrated healthcare intervention program and health policy, especially for the vulnerable older population with multimorbidity.
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Affiliation(s)
- Hyun-Ju Lee
- College of Nursing, Catholic University of Pusan, Busan, South Korea
| | - Misoon Lee
- Department of Nursing, Changshin University, Changwon, South Korea
| | - Jae-Hyun Ha
- Department of Nursing, Masan University, Changwon, South Korea
| | - Yeongsuk Lee
- College of Nursing, Catholic University of Pusan, Busan, South Korea
| | - Jungmi Yun
- College of Nursing, Pusan National University, Yangsan, South Korea.
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Miao JH, Wang HS, Liu N. The evaluation of a nurse-led hypertension management model in an urban community healthcare: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e20967. [PMID: 32629706 PMCID: PMC7337544 DOI: 10.1097/md.0000000000020967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hypertension is a silent disease of the masses with an increasing prevalence and poor control rates. This study aims to establish and test the efficacy of a nurse-led hypertension management model in the community. METHODS A single-blind, randomized controlled trial was performed. 156 hypertensive patients with uncontrolled blood pressure were equally and randomly allocated into 2 groups. Patients in the study group received a 12-week period of hypertension management. Blood pressure, self-care behaviors, self-efficacy, and satisfaction were assessed at the start of recruitment, 12 and 16 weeks thereafter. RESULTS After the intervention, blood pressure of patients in the study group had greater improvement in self-care behaviors and a higher level of satisfaction with the hypertensive care compared to the control group (both P < .05). CONCLUSIONS The nurse-led hypertension management model is feasible and effective for patients with uncontrolled blood pressure in the community.
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Affiliation(s)
| | | | - Na Liu
- TangShan Chinese Medicine Hospital, Heibei, P.R. China
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2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2020; 74:2661-2706. [PMID: 31732293 DOI: 10.1016/j.jacc.2019.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Feldman PH, McDonald MV, Trachtenberg M, Trifilio M, Onorato N, Sridharan S, Silver S, Eimicke J, Teresi J. Reducing Hypertension in a Poststroke Black and Hispanic Home Care Population: Results of a Pragmatic Randomized Controlled Trial. Am J Hypertens 2020; 33:362-370. [PMID: 31541606 PMCID: PMC7109355 DOI: 10.1093/ajh/hpz148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Uncontrolled hypertension (HTN) is a leading modifiable stroke risk factor contributing to global stroke disparities. This study is unique in testing a transitional care model aimed at controlling HTN in black and Hispanic poststroke, home health patients, an understudied group. METHODS A 3-arm randomized controlled trial design compared (i) usual home care (UHC), with (ii) UHC plus a 30-day nurse practitioner transitional care program, or (iii) UHC plus nurse practitioner plus a 60-day health coach program. The trial enrolled 495 black and Hispanic, English- and Spanish- speaking adults with uncontrolled systolic blood pressure (SBP ≥ 140 mm Hg) who had experienced a first-time or recurrent stroke or transient ischemic attack. The primary outcome was change in SBP from baseline to 3 and 12 months. RESULTS Mean participant age was 67; 57.0% were female; 69.7% were black, non-Hispanic; and 30.3% were Hispanic. Three-month follow-up retention was 87%; 12-month retention was 81%. SBP declined 9-10 mm Hg from baseline to 12 months across all groups; the greatest decrease occurred between baseline and 3 months. The interventions demonstrated no relative advantage compared to UHC. CONCLUSION The significant across-the-board SBP decreases suggest that UHC nurse/patient/physician interactions were the central component of SBP reduction and that additional efforts to lower recurrent stroke risk should test incremental improvements in usual care, not resource-intensive transitional care interventions. They also suggest the potential value of pragmatic home care programs as part of a broader strategy to overcome HTN treatment barriers and improve secondary stroke prevention globally. CLINICAL TRIALS REGISTRATION Trial Number NCT01918891.
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Affiliation(s)
- Penny H Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA
| | - Melissa Trachtenberg
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA
| | - Marygrace Trifilio
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA
| | - Nicole Onorato
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, USA
| | - Stephanie Silver
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Joseph Eimicke
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
| | - Jeanne Teresi
- Research Division, Hebrew Home at Riverdale, RiverSpring Health, Bronx, New York, USA
- Columbia University Stroud Center at New York State Psychiatric Institute, New York, USA
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Pletcher MJ, Fontil V, Carton T, Shaw KM, Smith M, Choi S, Todd J, Chamberlain AM, O’Brien EC, Faulkner M, Maeztu C, Wozniak G, Rakotz M, Shay CM, Cooper RM. The PCORnet Blood Pressure Control Laboratory: A Platform for Surveillance and Efficient Trials. Circ Cardiovasc Qual Outcomes 2020; 13:e006115. [PMID: 32142371 PMCID: PMC10681810 DOI: 10.1161/circoutcomes.119.006115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Uncontrolled blood pressure (BP) is a leading preventable cause of death that remains common in the US population despite the availability of effective medications. New technology and program innovation has high potential to improve BP but may be expensive and burdensome for patients, clinicians, health systems, and payers and may not produce desired results or reduce existing disparities in BP control. METHODS AND RESULTS The PCORnet Blood Pressure Control Laboratory is a platform designed to enable national surveillance and facilitate quality improvement and comparative effectiveness research. The platform uses PCORnet, the National Patient-Centered Clinical Research Network, for engagement of health systems and collection of electronic health record data, and the Eureka Research Platform for eConsent and collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. Three demonstration projects are underway: BP track will conduct national surveillance of BP control and related clinical processes by measuring theory-derived pragmatic BP control metrics using electronic health record data, with a focus on tracking disparities over time; BP MAP will conduct a cluster-randomized trial comparing effectiveness of 2 versions of a BP control quality improvement program; BP Home will conduct an individual patient-level randomized trial comparing effectiveness of smartphone-linked versus standard home BP monitoring. Thus far, BP Track has collected electronic health record data from over 826 000 eligible patients with hypertension who completed ≈3.1 million ambulatory visits. Preliminary results demonstrate substantial room for improvement in BP control (<140/90 mm Hg), which was 58% overall, and in the clinical processes relevant for BP control. For example, only 12% of patients with hypertension with a high BP measurement during an ambulatory visit received an order for a new antihypertensive medication. CONCLUSIONS The PCORnet Blood Pressure Control Laboratory is designed to be a reusable platform for efficient surveillance and comparative effectiveness research; results from demonstration projects are forthcoming.
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Affiliation(s)
- Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Valy Fontil
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Thomas Carton
- University of Florida, College of Medicine, Gainesville, FL
| | | | - Myra Smith
- University of Florida, College of Medicine, Gainesville, FL
| | - Sujung Choi
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC
| | | | | | - Emily C. O’Brien
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC
| | - Madelaine Faulkner
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | | | | | - Christina M. Shay
- Center for Health Metrics and Evaluation, American Heart Association
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41
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Kavita, Thakur JS, Vijayvergiya R, Ghai S. Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India. BMC Health Serv Res 2020; 20:10. [PMID: 31900134 PMCID: PMC6942281 DOI: 10.1186/s12913-019-4864-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality in India. CVDs are to a large extent preventable with the availability of wide range of interventions focusing on primary and secondary prevention. However human resource deficit is the biggest challenge for implementing these prevention programs. Task shifting of the cardiovascular risk assessment and communication to nurses can be one of the most viable and sustainable option to run prevention programs. METHODS The study was quasi experimental in nature with 1 year follow up to determine the effect of CVD risk assessment and communication by nurses with the help of risk communication package on primary and secondary prevention of CVDs. The study was done in the outpatient departments of a tertiary health care center of Northern India. All the nurses (n = 16) working in selected OPDs were trained in CVD risk assessment and communication of risk to the patients. A total of 402 patients aged 40 years and above with hypertension (HTN) were recruited for primary prevention of CVDs from medicine and allied OPDs, whereas 500 patients who had undergone CABG/PTCA were recruited from cardiology OPDs for secondary prevention of CVDs and were randomized to intervention (n = 250) and comparison group (n = 250) by using block randomization. CVD risk modification and medication adherence were the outcomes of interest for primary and secondary prevention of CVDs respectively. RESULTS The results revealed high level of agreement (k = 0.84) between the risk scores generated by nurses with that of investigator. In the primary prevention group, there were significantly higher proportion of participants in the low risk category (70%) as compared to baseline assessment (60.6%) at 1 year follow up. Whereas in secondary prevention group the mean medication adherence score among intervention group participants (7.60) was significantly higher than that of the comparison group (5.96) with a large effect size of 1.1.(p < 0.01). CONCLUSION Nurse led intervention was effective in risk modification and improving medication adherence among subjects for primary and secondary prevention of CVDs respectively. TRIAL REGISTRATION Trial registration no CTRI/2018/01/011372 [Registered on: 16/01/2018] Trial Registered Retrospectively.
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Affiliation(s)
- Kavita
- National Institute of Nursing Education Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - J. S. Thakur
- Department of Community medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - S. Ghai
- National Institute of Nursing Education Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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42
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Kavita K, Thakur J, Vijayvergiya R, Ghai S. Nurses role in cardiovascular risk assessment and communication: Indian nurses perspective. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_29_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
ZusammenfassungErhöhter Blutdruck bleibt eine Hauptursache von kardiovaskulären Erkrankungen, Behinderung und frühzeitiger Sterblichkeit in Österreich, wobei die Raten an Diagnose, Behandlung und Kontrolle auch in rezenten Studien suboptimal sind. Das Management von Bluthochdruck ist eine häufige Herausforderung für Ärztinnen und Ärzte vieler Fachrichtungen. In einem Versuch, diagnostische und therapeutische Strategien zu standardisieren und letztendlich die Rate an gut kontrollierten Hypertoniker/innen zu erhöhen und dadurch kardiovaskuläre Erkrankungen zu verhindern, haben 13 österreichische medizinische Fachgesellschaften die vorhandene Evidenz zur Prävention, Diagnose, Abklärung, Therapie und Konsequenzen erhöhten Blutdrucks gesichtet. Das hier vorgestellte Ergebnis ist der erste Österreichische Blutdruckkonsens. Die Autoren und die beteiligten Fachgesellschaften sind davon überzeugt, daß es einer gemeinsamen nationalen Anstrengung bedarf, die Blutdruck-assoziierte Morbidität und Mortalität in unserem Land zu verringern.
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Shlyakhto EV, Zvartau NE, Villevalde SV, Yakovlev AN, Soloveva AE, Alieva AS, Avdonina NG, Medvedeva EA, Fedorenko AA, Kulakov VV, Karlina VA, Endubaeva GV, Zaitsev VV, Soloviev AE. Cardiovascular risk management system: prerequisites for developing, organization principles, target groups. ACTA ACUST UNITED AC 2019. [DOI: 10.15829/1560-4071-2019-11-69-82] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vedanthan R, Ray M, Fuster V, Magenheim E. Hypertension Treatment Rates and Health Care Worker Density. Hypertension 2019; 73:594-601. [PMID: 30612489 DOI: 10.1161/hypertensionaha.118.11995] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Elevated blood pressure is the leading cause of death worldwide; however, treatment and control rates for hypertension are low. Here, we analyze the relationship between physician and nurse density and hypertension treatment rates worldwide. Data on hypertension treatment rates were collected from the STEPwise approach to Surveillance country reports, individual studies resulting from a PubMed search for articles published between 1990 and 2010, and manual search of the reference lists of extracted studies. Data on health care worker density were obtained from the Global Atlas of the Health Workforce. We controlled for a variety of variables related to population characteristics and access to health care, data obtained from the World Bank, World Development Indicators, United Nations, and World Health Organization. We used clustering of SEs at the country level. Full data were available for 154 hypertension treatment rate values representing 68 countries between 1990 and 2010. Hypertension treatment rate ranged from 3.4% to 82.5%, with higher treatment rates associated with higher income classification. Physician and nurse/midwife generally increased with income classification. Total healthcare worker density was significantly associated with hypertension treatment rate in the unadjusted model ( P<0.001); however, only nurse density remained significant in the fully adjusted model ( P=0.050). These analyses suggest that nurse density, not physician density, explains most of the relationship with hypertension treatment rate and remains significant even after adjusting for other independent variables. These results have important implications for health policy, health system design, and program implementation.
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Affiliation(s)
- Rajesh Vedanthan
- From the Section for Global Health, Department of Population Health, New York University School of Medicine, NY (R.V.)
| | - Mondira Ray
- University of Pittsburgh School of Medicine, PA (M.R.)
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, NY (V.F.)
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46
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Martínez-Mardones F, Fernandez-Llimos F, Benrimoj SI, Ahumada-Canale A, Plaza-Plaza JC, S Tonin F, Garcia-Cardenas V. Systematic Review and Meta-Analysis of Medication Reviews Conducted by Pharmacists on Cardiovascular Diseases Risk Factors in Ambulatory Care. J Am Heart Assoc 2019; 8:e013627. [PMID: 31711390 PMCID: PMC6915276 DOI: 10.1161/jaha.119.013627] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Pharmacists‐led medication reviews (MRs) are claimed to be effective for the control of cardiovascular diseases; however, the evidence in the literature is conflicting. The main objective of this meta‐analysis was to analyze the impact of pharmacist‐led MRs on cardiovascular disease risk factors overall and in different ambulatory settings while exploring the effects of different components of MRs. Methods and Results Searches were conducted in PubMed, Web of Science, Embase, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library Central Register of Controlled Trials database. Randomized and cluster randomized controlled trials of pharmacist‐led MRs compared with usual care were included. Settings were community pharmacies and ambulatory clinics. The classification used for MRs was the Pharmaceutical Care Network Europe as basic (type 1), intermediate (type 2), and advanced (type 3). Meta‐analyses in therapeutic goals used odds ratios to standardize the effect of each study, and for continuous data (eg, systolic blood pressure) raw differences were calculated using baseline and final values, with 95% CIs. Prediction intervals were calculated to account for heterogeneity. Sensitivity analyses were conducted to test the robustness of results. Meta‐analyses included 69 studies with a total of 11 644 patients. Sample demographic characteristics were similar between studies. MRs increased control of hypertension (odds ratio, 2.73; 95% prediction interval, 1.05–7.08), type 2 diabetes mellitus (odds ratio, 3.11; 95% prediction interval, 1.17–5.88), and high cholesterol (odds ratio, 1.91; 95% prediction interval, 1.05–3.46). In ambulatory clinics, MRs produced significant effects in control of diabetes mellitus and cholesterol. For community pharmacies, systolic blood pressure and low‐density lipoprotein values decreased significantly. Advanced MRs had larger effects than intermediate MRs in diabetes mellitus and dyslipidemia outcomes. Most intervention components had no significant effect on clinical outcomes and were often poorly described. CIs were significant in all analyses but prediction intervals were not in continuous clinical outcomes, with high heterogeneity present. Conclusions Intermediate and advanced MRs provided by pharmacists may improve control of blood pressure, cholesterol, and type 2 diabetes mellitus, as statistically significant prediction intervals were found. However, most continuous clinical outcomes failed to achieve statistical significance, with high heterogeneity present, although positive trends and effect sizes were found. Studies should use a standardized method for MRs to diminish sources of these heterogeneities.
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Affiliation(s)
| | - Fernando Fernandez-Llimos
- Institute for Medicines Research (iMed.ULisboa) Department of Social Pharmacy Faculty of Pharmacy University of Lisbon Portugal
| | - Shalom I Benrimoj
- Member of the Pharmaceutical Care Research Group University of Granada Faculty of Pharmacy Campus Universitario Cartuja Granada Spain
| | | | | | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme Federal University of Paraná Curitiba Brazil
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Casey DE, Thomas RJ, Bhalla V, Commodore-Mensah Y, Heidenreich PA, Kolte D, Muntner P, Smith SC, Spertus JA, Windle JR, Wozniak GD, Ziaeian B. 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2019; 12:e000057. [PMID: 31714813 DOI: 10.1161/hcq.0000000000000057] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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48
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Derington CG, King JB, Bryant KB, McGee BT, Moran AE, Weintraub WS, Bellows BK, Bress AP. Cost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care. Curr Hypertens Rep 2019; 21:91. [PMID: 31701259 DOI: 10.1007/s11906-019-0996-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Review the effectiveness, cost-effectiveness, and implementation challenges of intensive blood pressure (BP) control and team-based care initiatives. RECENT FINDINGS Intensive BP control is an effective and cost-effective intervention; yet, implementation in routine clinical practice is challenging. Several models of team-based care for hypertension management have been shown to be more effective than usual care to control BP. Additional research is needed to determine the cost-effectiveness of team-based care models relative to one another and as they relate to implementing intensive BP goals. As a focus of healthcare shifts to value (i.e., cost, effectiveness, and patient preferences), formal cost-effectiveness analyses will inform which team-based initiatives hold the highest value in different healthcare settings with different populations and needs. Several challenges, including clinical inertia, financial investment, and billing restrictions for pharmacist-delivered services, will need to be addressed in order to improve public health through intensive BP control and team-based care.
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Affiliation(s)
- Catherine G Derington
- Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA.,Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jordan B King
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, 84112, USA
| | - Kelsey B Bryant
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Blake T McGee
- Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, GA, USA
| | - Andrew E Moran
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Brandon K Bellows
- Division of General Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Adam P Bress
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84112, USA.
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Jordan AN, Anning C, Wilkes L, Ball C, Pamphilon N, Clark CE, Bellenger NG, Shore AC, Sharp ASP. Rapid treatment of moderate to severe hypertension using a novel protocol in a single-centre, before and after interventional study. J Hum Hypertens 2019; 34:165-175. [PMID: 31645638 DOI: 10.1038/s41371-019-0272-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
Rapid treatment to target in hypertension may have beneficial effects on long-term outcomes. This has led to a new recommendation in the 2018 European hypertension guidelines for patients with grade II/III hypertension to be treated to target within three months. However, whether it is feasible and safe to quickly manage treatment-naïve grade II/III hypertension to target was unclear. We examined this using a single-centre before and after interventional study, treating newly diagnosed, never-treated, grade II/III hypertensive patients with a daytime average systolic ABP ≥ 150 mmHg to target within 18 weeks. The proportion at office target BP at 18 weeks was determined, together with office and ambulatory BP change from baseline to after the intervention. The protocol was designed to maximise medication adherence, including a low threshold for treatment adaptation. Safety was evaluated through close monitoring of adverse events and protocol discontinuation. Fifty-five participants were enrolled with 54 completing the protocol. 69 ± 12.3% were at office target BP at their final visit, despite a high average starting BP of 175/103 mmHg, as a consequence of significant reductions in both office and ambulatory BP. Of those at office target BP, 51% were above target on ambulatory measurement. Adherence testing demonstrated that 92% of participants were adherent to treatment at their final visit. Therefore we conclude that the accelerated management of treatment-naïve grade II/III hypertension is feasible and safe to implement in routine practice and there is no evidence to suggest it causes harm. Further large-scale randomised studies of rapid, adaptive treatment, including a cost-effectiveness analysis, are required.
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Affiliation(s)
- Andrew N Jordan
- NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK.,Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Christine Anning
- NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK
| | - Lindsay Wilkes
- NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK
| | - Claire Ball
- NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK
| | - Nicola Pamphilon
- NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK
| | - Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2 LU, UK
| | - Nicholas G Bellenger
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.,Department of Cardiology, Royal Devon and Exeter Hospital, Exeter and University Hospital of Wales, Cardiff, UK
| | - Angela C Shore
- NIHR Exeter Clinical Research Facility, Vascular Medicine, Exeter, UK.,Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Andrew S P Sharp
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK. .,Department of Cardiology, Royal Devon and Exeter Hospital, Exeter and University Hospital of Wales, Cardiff, UK.
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50
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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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