NURSFPX 4900 Assessment 2: Assessing the Problem: Quality, Safety, and Cost Considerations

Introduction

If your blood pressure readings consistently show that your systolic number is more than 130 mm Hg or your diastolic number is greater than 80 mm Hg, you may be suffering from hypertension, a chronic medical disease characterized by high blood pressure. More than a billion individuals throughout the globe suffer from hypertension, which increases their risk of cardiovascular disease, stroke, renal illness, and other ailments. Hypertension affects over 45 percent of American people between the ages of 40 and 59, as reported by the Centers for Disease Control and Prevention (CDC). Stroke, heart disease, and renal failure are just some of the catastrophic outcomes that may result from poorly treated hypertension. Lifestyle modifications, including a nutritious diet, frequent physical exercise, and the avoidance of nicotine and excessive alcohol intake, are often effective in controlling hypertension. Many m patients, however, are unwilling to make the necessary lifestyle adjustments, despite the fact that doing so would greatly improve their health and reduce their healthcare expenses, as well as those of the healthcare system as a whole.

Impact on Quality of Care

Care quality rises when hypertension is effectively managed by modifying patient behavior. Reducing blood pressure in hypertension individuals has been proven to be possible with the adoption of good lifestyle habits including eating well and exercising regularly. Stroke, heart attack, and renal disease are just some of the consequences that may be avoided with better control of hypertension. Complications associated with uncontrolled hypertension have been linked to subpar treatment quality (Tam et al., 2020).

The American Heart Association reports that hypertension contributes to the development of cardiovascular disease and stroke, the first and fifth leading causes of mortality in the country, respectively. Because of these setbacks, patients often end up spending more time in the hospital, having to be readmitted, and receiving lower-quality treatment overall. Improved hypertension control leads to happier patients. Successful management of blood pressure by lifestyle modifications may make patients feel more in charge of their health and improve their outlook on medical treatment. Patients with high blood pressure who made changes to their diet and exercise routines had significant drops in their readings. Patients with hypertension benefit greatly from lifestyle treatments in terms of both blood pressure management and quality of life (Tam et al., 2020).

This data is in line with what is seen in the field of nursing. Educating patients on how to modify their lifestyle in order to lower their blood pressure is a common job for nurses, and many patients find that they are able to effectively do so, leading to better health outcomes. Some patients may find it difficult to make the necessary lifestyle adjustments due to variables such as their socioeconomic status or a lack of convenient and secure locations at which to engage in healthy behaviors like eating and physical activity. The role of the nurse is critical in assisting patients in managing their hypertension by removing these obstacles and providing necessary assistance and resources.

Impact on Patient Safety

Patients with hypertension are at higher risk for cardiovascular complications including stroke and heart attack. Improved patient safety may result from making adjustments to one's lifestyle that lower blood pressure. Falls and other injuries may occur as a result of high blood pressure symptoms including dizziness, fainting, and disorientation if they are not treated. It also makes surgery and anaesthesia more dangerous. Complications after surgery were more common in patients whose hypertension was not under control (Frassanito et al., 2023) than in those whose blood pressure was. Patients whose blood pressure is under control have a decreased risk of problems after surgery than those whose hypertension is uncontrolled. Hypertension control is crucial for patient safety during surgery, as noted by (Frassanito et al., 2023).

Taking control of one's blood pressure via lifestyle modifications has been shown to considerably lower the likelihood of adverse events and increase patient safety. Patients with hypertension may greatly benefit from weight reduction, exercise, and dietary changes, which together can considerably lower blood pressure and the risk of cardiovascular events. By increasing one's fitness level and enhancing one's balance and coordination, these modifications may lessen the likelihood of injury from falls (Tam et al., 2020). As a nurse, I've seen firsthand how high blood pressure may compromise patient health and the value of adopting healthy habits to lower it. I have seen people who have had issues like falls and accidents because their hypertension was not under control. Helping patients control their blood pressure and enhance their health and safety may be accomplished by encouraging them to adopt healthier lifestyle habits including eating well, getting regular exercise, and lowering their stress levels.

Impact on Costs

Hypertension and its consequences may have a substantial financial impact on healthcare budgets. Lifestyle changes to control blood pressure, on the other hand, may be a cost-effective method of managing hypertension since they can lower the need for medication and the risk of problems that need hospitalization or other costly treatments. About $131 billion a year is spent on healthcare, drugs, and lost productivity due to hypertension in the United States, according the Centres for Disease Control and Prevention (CDC). The rising expense of healthcare is mostly attributable to the fact that people with uncontrolled hypertension spend more time in the hospital, are readmitted more often, and need more drugs.

 The financial impact of hypertension was studied by Kes & Polat (2022). The research analysed the expenses of hypertension in various areas and nations by a systematic evaluation of previous studies. A substantial financial impact on people, healthcare institutions, and the community as a whole was discovered to be associated with hypertension. Hypertension has a high direct cost, as indicated by the authors (Kes & Polat, 2022) because to things like medication, hospitalisation, and doctor visits, and a large indirect cost due to things like lost productivity and worse quality of life.

 The financial burden of hypertension was also shown to differ significantly across regions and countries, with greater expenses in wealthy nations and lower costs in poor nations. The findings of this research emphasise the need of coordinated global initiatives to prevent and treat hypertension in order to lessen the disease's monetary impact. Hypertension places a heavy financial burden on people, healthcare institutions, and the public as a whole, and the information presented in this article lends credence to this claim. People with uncontrolled hypertension incur high healthcare costs due to their use of drugs, office visits, and other medical interventions (Kes & Polat, 2022).

Prescription drug prices often range from one pharmacy to another and from patient to patient. Some hypertension drugs, such ACE inhibitors and ARBs (angiotensin receptor blockers), may be rather expensive. Over time, the cost of healthcare expenses including doctor visits and prescriptions may pile up. Complications from untreated hypertension may cause patients to miss work, which adds up to further lost income. Hospitalization and lost time from work are associated with hypertension because of the increased risk of cardiovascular events such heart attacks and strokes ("AMA, n.d.").

Kamboj et al., (2023) looked at the monetary effect of controlling hypertension in the USA. The analysis concluded that hypertension is linked to substantial output loss owing to absenteeism, diminished work capability, and retirement at an earlier age. Hypertension is expected to cost billions of dollars yearly in direct and indirect expenses, such as medical bills and missed work time. Hypertension management programs that encourage blood pressure control and lower the burden of hypertension-related consequences were also recognized as having the potential to save money in the study. The authors argue that money put into hypertension treatment programs will pay off in the form of lower healthcare costs and increased productivity.

Impact of Health Policy on Quality and Cost of Care

The management of hypertension in patients of middle age is significantly influenced by the standards of nursing practice established by state boards. In order to enhance the quality of care, patient safety, and cost-effectiveness, these policies and guidelines may guide healthcare professionals and institutions in the implementation of evidence-based practises and interventions. Patients' hypertension should be evaluated and treated according to these principles. The American Nurses Association (ANA) has developed nursing practise standards that address hypertension and recommend that nurses assess patients' blood pressure at each visit, educate patients about hypertension, and partner with other medical professionals to establish a strategy of care that includes lifestyle modifications and medications as needed (Rosende et al., 2023) to treat hypertension.

The American Nurses Association also suggests that nurses adopt the American Heart Association's evidence-based practise recommendations for hypertension evaluation and therapy. Losing weight, getting regular exercise, and eating a nutritious diet are all suggested as ways to lower blood pressure within these limits (AHA, n.d.). Nurses also provide advice on how to effectively manage hypertension with drugs including diuretics, ACE inhibitors, and beta-blockers. Providers may be certain that they are giving their hypertensive patients the best possible treatment thanks to these recommendations. Implementing evidence-based hypertension treatment regimens in primary care settings was the subject of a systematic study published in the Journal of the American Medical Association in 2014. They discovered that systolic blood pressure was reduced by an average of 5.6 mmHg and diastolic blood pressure was reduced by an average of 3.5 mmHg when patients followed these regimens. Stroke and heart attack rates were shown to be lower in populations following these regimens.

Reviewing the evidence supporting the success of following guidelines for hypertension therapy, the article "Guideline-Driven Management of Hypertension: An Evidence-Based Update" provides an in-depth analysis of the topic. The authors draw the conclusion that evidence-based recommendations are useful in enhancing hypertension therapy and decreasing the prevalence of problems connected to hypertension. Even though following guidelines is linked to better patient outcomes, the research emphasizes that there is sometimes a chasm between what is recommended by guidelines and what is actually done in clinical settings. McClellan et al. (2019) call for healthcare personnel to receive continual education and training, as well as for the creation of procedures and instruments to aid in the implementation of evidence-based standards.

The efficacy of a multidimensional intervention to enhance hypertension treatment in primary care settings was assessed by Gyawali et al., (2023). Clinical practise standards, provider and patient education, and assistance with medication management were all part of the intervention. Significant improvements in blood pressure management were seen when the intervention was implemented, as measured by a mean decrease in systolic blood pressure of 11.8 mmHg and a mean decrease in diastolic blood pressure of 5.8 mmHg. The intervention was linked to a statistically significant decrease in hypertension-related hospitalisations. These studies show that nurse practise standards, organisational policies, and government regulations have a positive impact on care quality, patient safety, and cost-effectiveness in the administration of hypertension. Improving health outcomes and lowering healthcare costs depend on healthcare professionals and institutions having access to evidence-based advice and assistance. When dealing with hypertension in middle-aged patients, I can be certain that I will be adhering to evidence-based protocols for evaluation, treatment, and education thanks to the standards and principles laid forth here. Patients should be screened for hypertension on a regular basis, their risk for problems evaluated, and then treatment programs tailored to each patient's needs created, which may involve both lifestyle changes and drug management. In order to provide my patients, the best treatment possible, I must also keep up with the latest medical research and practice recommendations.

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The pricing and accessibility of hypertension treatment services for patients are affected by policies and regulations pertaining to healthcare payment and insurance coverage. Potentially limiting factors for hypertension treatment programs and research include changes in healthcare rules or financing. The treatment of hypertension is the subject of several rules and laws. One million heart attacks and strokes are expected to be avoided by 2022 thanks in part to the Million Hearts program, which is working to better control hypertension. Coverage for blood pressure testing and more money for community health centers are only two examples of the ACA's contributions to hypertension treatment. Research and assessment of the efficacy of these laws and regulations in enhancing hypertension treatment and decreasing associated expenses is continuing.

Processes to Improve Quality, Enhance Patient Safety, And Reduce the Cost of Care

There is a wealth of literature on the efficacy of interventions designed to enhance service quality, increase patient safety, and decrease the financial burden of hypertension therapy. Implementing evidence-based hypertension treatment strategies in primary care settings was related with better blood pressure control and lower risks of cardiovascular events, according to a study published in JAMA. Medication management, lifestyle changes, and patient education were shown to significantly lower blood pressure and cardiovascular events in the evaluation of 40 randomized clinical trials involving over 100,000 patients (Rosende et al., 2023). Effective hypertension management requires a multifaceted strategy that incorporates counselling and education, behavioral and dietary changes, pharmaceutical therapies, and consistent monitoring of blood pressure, as stated by Beany et al. (2020). The authors stress the need of healthcare professionals and organizations working together across disciplines to effectively combat hypertension. The authors highlight the significance of data and quality improvement activities in the continual evaluation and optimization of hypertension control programmers. Evidence-based solutions and best practices for hypertension prevention and control, care quality improvement, patient safety, and healthcare cost reduction are outlined in detail.

In addition, there are a plethora of resources from which to get benchmark data on the quality of treatment, patient safety, and costs connected with hypertension management. Benchmarks for blood pressure control rates in individuals with hypertension are provided by the National Committee for Quality Assurance (NCQA), while the Agency for Healthcare Research and Quality (AHRQ) offers statistics on hospitalization rates and expenditures associated with complications from hypertension. The CDC also publishes information on the national and state levels about the prevalence of hypertension as well as the expenditures associated with it. Interventions to better control hypertension and cut down on complications and expenditures have good evidence in their favor. The availability of benchmark data allows healthcare providers and organizations to track their progress towards these targets and pinpoint areas for improvement.

Conclusion

The effects of hypertension on service quality, patient safety, and financial burdens on both the healthcare system and individuals make it a major public health concern. Care quality, patient safety, and cost-effectiveness may all be enhanced by implementing evidence-based practices and treatments in accordance with nursing practice standards established by state boards of nursing and organizational or governmental policies. Evidence-based hypertension treatment regimens have been found to enhance blood pressure control and lower incidence of cardiovascular events when used in primary care settings. The pricing and accessibility of hypertension treatment services for patients is also affected by policies and regulations pertaining to healthcare payment and insurance coverage. Therefore, healthcare practitioners and policymakers must maintain a focus on hypertension treatment and create new approaches to successfully combat this public health issue.

References

American Heart Association. (n.d.). High Blood Pressure. Retrieved April 2, 2023, from https://www.heart.org/en/health-topics/high-blood-pressure

Beaney, T., Schutte, A. E., Stergiou, G. S., Borghi, C., Burger, D., Charchar, F., ... & MMM Investigators*. (2020). May Measurement Month 2019: The global blood pressure screening campaign of the International Society of Hypertension. Hypertension, 76(2), 333-341. https://doi.org/10.1161/HYPERTENSIONAHA.120.14874

Frassanito, L., Giuri, P. P., Vassalli, F., Piersanti, A., Garcia, M. I. M., Sonnino, C., ... & Draisci, G. (2023). Hypotension Prediction Index guided Goal Directed therapy and the amount of Hypotension during Major Gynaecologic Oncologic Surgery: a Randomized Controlled clinical Trial. Journal of Clinical Monitoring and Computing, 1-13. https://doi.org/10.1007/s10877-023-01017-1

Gyawali, B., Ratib, D., Dræbel, T., Kyanddodo, D., Nakanjako, R., Nanfuka, E., ... & Skovdal, M. (2023). Factors associated with continuity of care in hypertension and type 2 diabetes among forcibly displaced persons in the Bidibidi refugee settlement in Uganda: Protocol for a cross-sectional, mixed-methods study. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2023.02.017

Kamboj, A., Brown, M. M., & Abel, A. S. (2023, January). Intracranial Hypertension Associated With Testosterone Therapy In Female-To-Male Transgender Patients: A Case Report And Literature Review. In Seminars in Ophthalmology (pp. 1-6). Taylor & Francis. https://doi.org/10.1080/08820538.2023.2169578

Kes, D., & Polat, U. (2022). The effect of nurse‐led telephone support on adherence to blood pressure control and drug treatment in individuals with primary hypertension: A randomized controlled study. International Journal of Nursing Practice, 28(3), e12995. https://doi.org/10.1111/ijn.12995

McClellan, M., Brown, N., Califf, R. M., & Warner, J. J. (2019). Call to action: Urgent challenges in cardiovascular disease: a presidential advisory from the American Heart Association. Circulation, 139(9), e44-e54. https://doi.org/10.1161/CIR.0000000000000652

Rosende, A., DiPette, D., Brettler, J., Rodríguez, G., Zuniga, E., Connell, K., & Ordunez, P. (2023). HEARTS in the America's appraisal checklist and clinical pathway for comprehensive hypertension management in primary care. Revista Panamericana de Salud Pública, 46, e125.  https://doi.org/10.26633/RPSP.2022.125

Tam, H. L., Wong, E. M. L., & Cheung, K. (2020). Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: an integrative review. International journal of environmental research and public health, 17(7), 2513. https://doi.org/10.3390/ijerph17072513

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