Advancing Hypertension (HTN) Control & Self-Management

Monday, 18 November 2013: 3:35 PM

Maureen O'Hagan Lobb, PhD, RN, CDE
Office of Nursing and Patient Care Services, Atlanta Veteran's Administration Medical Center, Decatur, GA
LaGaunda C. Jones, MS, RN, NEA-BC
Department of Medicine, Atlanta VA Medical Center (Magnet designated), Decatur, GA
Phyllis J. Vaughn, BSN, RN
Department of Medicine, Renal Division, Emory University, Atlanta, GA
Mercy Cherian, RN
Department of Medicine, Atlanta VA Medical Center, Decatur, GA
Annamma Kumpalappallil, RN
Medical Specialty Clinics, Atlanta VA Medical Center, Decatur, GA

Learning Objective 1: The learner will be able to describe obstacles to achieving hypertension control and health-care provider practice considerations to maximize patient adherence to antihypertensive medication regiments.

Learning Objective 2: The learner will be able to Identify tools to focus provider attention on out-of-range blood pressures during clinic visits.

Hypertension, the most common chronic condition, affects 68 million Americans at a cost of $131 billion annually in direct medical expenses.1 Major obstacles to achieving HTN control include lack of aggressive provider response to uncontrolled blood pressure and non-optimal self-management, including insufficient patient adherence and persistence with HTN treatment regimens. Half of patients diagnosed with HTN stop taking their medication within one year.2,3  In response to deficiencies in meeting benchmarks (BM) for clinic patients in a large urban medical center, a program to advance HTN control and self-management was implemented in one outpatient medical clinic. Provider Alert Cards were introduced as a pilot to notify providers of elevated values on appointment day. Nurses also educated patients on modifiable risks to decrease blood pressure and technological resources to support risk reduction efforts (electronic health record, provider email access etc); they followed up by phone to assess and encourage self-management, timely prescription refills, and adherence to medication regimens. Patients were provided with home blood pressure monitoring devices and logs for recording readings. Instructions were given on actions to take for out of range values. Upon implementing this intervention, the next four quarter’s BM’s for HTN control exceeded facility standards and led to sharing the innovation with all Medical Center clinics. Subsequent HTN data demonstrate sustained improvement across the outpatient settings. In conclusion, promoting optimal HTN control and self-management requires a multifaceted, interdisciplinary approach. Implications for nursing practice include individualize assessment and patient-nurse collaboration in planning care to minimize obstacles and maximize adherence and persistence with regime. Provider alerts are an important tool for focusing attention on out-of-range blood pressure readings during clinic visits. 2,3,4