Nurse-Led Email Reminder for Hypertensive Patients Essay
Nurse-Led Email Reminder for Hypertensive Patients Essay
Research title and authors
The article under analysis is called “Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: A randomized controlled trial.” It was written by Cicolini et al. and published in 2013.
Research problem and purpose
The article targets the issue of hypertension management. The issue is addressed using email reminder. Nurse-Led Email Reminder for Hypertensive Patients Essay. The purpose is to save time and effort. Nurses reach the patients on distance. Nurses ensure better condition management.
Literature review
The literature review is in the introduction. The authors review many sources. Nurse-Led Email Reminder for Hypertensive Patients Essay. All of them are recent. All sources are relevant. The authors provide an issue background. The importance of CVD intervention is discussed. There is a need for improvement.
Research objectives, questions, or hypothesis
The objective is to assess NRP-e effectiveness. NRP-e is hypothesized as a cost-effective intervention. The rationale is the lack of such studies. Question: do patients benefit from NRP-e? Theory: NRP-e helps nurses and patients.
Variables
Variables: gender, age of the patients. More variables: BMI, alcohol consumption. Nurse-Led Email Reminder for Hypertensive Patients Essay. The research focused on lifestyle—main factors: diet, smoking, activity. The study measured intervention compliance. Biological variables: BP, blood glucose, cholesterol.
Design
Study design: a randomized controlled trial. Length: October 2011 – May 2012. Location: Italian Hypertension Primary Care Center. The study met ethical concerns. It was approved by the Ethics Committee of the University of the Abruzzo Region.
Sample, population, and setting
Target population: adults diagnosed with hypertension. Inclusion criteria: knowing the Italian language. Additional criteria: having e-mail and phone. The participants signed informed consent. Sample: divided into intervention and control groups. Sampling: random; researchers were blinded. Setting: home (patients), hospital (nurses). Nurse-Led Email Reminder for Hypertensive Patients Essay.
Intervention description
The educational program was developed. Intervention: delivered via email, phone. Time: 1-hour sessions 3-4 times a week. Content: advice on condition management. Other content: tips on lifestyle choices.Nurse-Led Email Reminder for Hypertensive Patients Essay. Materials: table of food classification.
Measurements
Outcome assessment: during follow-up visits. Means used: validated questionnaires. Other means: lab testing (blood). Outcomes assessed: CVD risk factors. Factors measured: diet, glucose, physical activity. Other measurements: treatment adherence.
Data collection
Data obtained: via questionnaires. Lab data: from blood tests. Factors assessed: blood glucose, BP. More factors: BMI, lifestyle, and diet reports. Intervention compliance: the appearance at follow-ups.
Data analyses
Data analysis: using the Shapiro–Wilk test. Differences over time periods: t-test. For variables distributed non-normally: Kruskal– Wallis test. For dichotomized variables: chi-square. Comparisons: Wilcoxon matched-pairs signed-ranks test. Nurse-Led Email Reminder for Hypertensive Patients Essay.
Mean differences: Kruskal– Wallis test.
Data presentation
Data was presented in a table. Each factor was calculated separately. Advantages: excellent visibility and comprehensiveness. Research design: presented via a graph. The graph showed each step of work with the sample.
Results of the study
The decrease in CVD risk factors found in both groups. Factor without change: salt intake. Intervention group: greater improvement. Nurse-Led Email Reminder for Hypertensive Patients Essay.Namely: BMI, BP, diet, lifestyle. Intervention group: better results in every factor. Intervention made no effect on salt intake.
Interpretation of findings
NRP-e is very effective for patients. Statistically better results in the intervention group. Conclusion: NRP-e works for each CVD factor. Results agree with previous findings. Compared to other studies: it affected more factors.
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Limitations
The time of follow-up provision was short. No long-term assessment was conducted. No knowledge of the effects on major outcomes. Namely: stroke, myocardial infarction rates.
Implications
NRP-e is helpful for nurses. NRP-e allows for better workplace flexibility. It requires little time and effort. Nurses produce better effects. Conclusion: NRP-e is cost-effective.
The role of the nurse in improving hypertension control has expanded over the past 50 years, complementing and supplementing that of the physician. Nurses’ involvement began with measuring and monitoring blood pressure (BP) and patient education and has expanded to become one of the most effective strategies to improve BP control. Today the roles of nurses and nurse practitioners (NPs) in hypertension management involve all aspects of care, including (1) detection, referral, and follow up; (2) diagnostics and medication management; (3) patient education, counseling, and skill building; (4) coordination of care; (5) clinic or office management; (6) population health management; and (7) performance measurement and quality improvement. The patient-centered, multidisciplinary team is a key feature of effective care models that have been found to improve care processes and control rates.Nurse-Led Email Reminder for Hypertensive Patients Essay. In addition to their clinical roles, nurses lead clinic and community-based research to improve the hypertension quality gap and ethnic disparities by holistically examining social, cultural, economic, and behavioral determinants of hypertension outcomes and designing culturally sensitive interventions to address these determinants.
Interventions We report on a package of interventions where community-based cardiovascular disease (CVD) nurses were trained by FHI 360. CVD nurses confirmed diagnoses of known hypertensives and newly screened individuals. Participants were treated according to the clinical guidelines established through the project’s Technical Steering Committee. Patients received three types of reminder and adherence messages. We used CommCare, a cloud-based system, as a case management and referral tool.
Primary outcome Hypertension control defined as blood pressure (BP) under 140/90 mm Hg. Secondary outcomes: changes in BP and knowledge of risk factors for hypertension.
Results After 1 year of intervention, 72% (95% CI: 67% to 77%) of participants had their hypertension under control. Systolic BP was reduced by 12.2 mm Hg (95% CI: 14.4 to 10.1) and diastolic BP by 7.5 mm Hg (95% CI: 9.9 to 6.1). Due to low retention, we were unable to look at knowledge of risk factors. Factors associated with remaining in the programme for 12 months included education, older age, hypertension under control at enrolment and enrolment date. The majority of patients who remained in the programme were on treatment, with two-thirds taking at least two medications. Nurse-Led Email Reminder for Hypertensive Patients Essay.
Conclusions Patients retained in ComHIP had increased BP control. However, high loss to follow-up limits potential public health impact of these types of programmes. To minimise the impact of externalities, programmes should include standard procedures and backup systems to maximise the possibility that patients stay in the programme.
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