Chronic conditions contribute to high morbidity, mortality, and economic costs in the United States. One major chronic condition is hypertension (HTN). HTN puts people at greater risk for heart disease and stroke, which are the leading causes of death in the United States. More than 400,000 Americans die every year due to HTN, that is more than 1,110 deaths each day.
In the United States, one in three adults, approximately 75 million Americans, has HTN. Almost half (54%) do not have their HTN under control. 11 million Americans are unaware that their blood pressure (BP) is high and they do not seek treatment to control it; yet most have healthcare assess and insurance. These Americans are they are “hiding in plain sight” in our healthcare centers.
Similarly, in Wisconsin, about one of three adults, 1.3 million, has HTN. Approximately 16% of adults in WI are unaware they have HTN. Less than 50% of these adults with HTN has their BP controlled. Because 82.5% of adults with uncontrolled HTN have healthcare access, they are “hiding in plain sight” in our healthcare centers in WI. Nurse leaders are ideally situated to improve control of HTN in a variety of roles and strategies.
Purposes:
1) To describe how nurse leaders created an interdisciplinary, statewide collaborative to improve HTN prevention, detection, and management
2) To stimulate interest and engagement by other nurse leaders to create similar collaboratives and initiativies.
Methods
Nurse leaders in public health and the Wisconsin Nursing Association (WNA) collaborated with the Chronic Disease Prevention Program (CDPP) of Wisconsin Department of Health Service, Division of Public Health to secure funding. With funding from the Centers for Disease Control, aims were to: (1) Increase HTN prevention, detection, and treatment; (2) Improve systems for prevention, and (3) Advance a new model of patient-centered, team-based care.
Results
WNA established an Interprofessional Clinical HTN Expert Panel with 20 members and 10 consultants, including nurse leaders. This Panel generated 10 overall recommendations with practical strategies to improve systems to control HTN, based on evidence from both national and international databases. For example, if RNs could work to the top of their licenses, then they could contribute greatly to HTN control. WNA developed an evidence-based program, Beyond the 50%: It Starts with Blood Pressure Measurement, with resources from the American Medical Association, to increase accuracy of BP measurement. More than 125 nurses participated in Beyond the 50% Program. All participants identified evidence based strategies they could incorporate into their practice to help prevent and treat HTN.
Conclusions
Nurses and health professionals across the country can adopt many of these strategies. Clinicians can implement the Expert Panels’ practical strategies for HTN control, utilize programs such as Beyond the 50%, and collaborate to implement and evaluate a new patient-centered, team-based model. With these efforts, nurse leaders could build capacity to control HTN with clients, clinics, and populations, and reduce illness and death due to HTN in the US.
Next steps
To improve prevention, detection, and treatment of HTN, nurses can:
- Participate in Beyond the 50% Program to ensure they assess and maintain highest standards in BP measurement wherever they work.
- Facilitate partnerships among a breadth of stakeholders, including state health departments, professional nursing organizations, health care organizations, schools of nursing, community groups, and funders
- Collaborate with health care administrators to review the Expert Panel’s recommendations and choose which strategies they could adopt feasibly in their organizations
- Partner with nurse scholars to conduct QI projects to a) identify how nurses can address system-related barriers to HTN prevention, screening, and referral as well as b) evaluate implementation strategies for a new person-centered, team-based model of care
- Work with nurse researchers to test the effects of patient-centered interventions designed to prevent or control HTN, delivered by nurses, based on theories and research.
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