Dissertations / Theses on the topic 'Hypertension Patient education'

This study examined the difference among 3 patient education intervention strategies and compliance in the hypertensive elderly. The strategies were verbal instructions, written instructions and both verbal and written instructions. An ex post facto descriptive design was implemented based on a Cognitive Information Processing Theory of Learning. Forty subjects were recruited and interviewed. Data analysis revealed that compliance did not differ significantly with the type of educational strategy.

The prevalence of hypertension in African Americans is the highest of any population in the United States, and this population also demonstrates lower rates of adherence to mediation. Social support and patient-provider communication have been considered as reinforcing factors to help hypertensive patients achieve optimal blood pressure control. The purpose of this study was to examine the association of social support and patient-provider communication and medication adherence for hypertensive African American men and women. The study was guided by the theory of reasoned action. This study was conducted to determine whether social support and patient-provider communication was associated with medication adherence by self-report, age, and gender. A quantitative cross-sectional design with secondary data analyses was used. The sample included 566 hypertensive African American men and women between the ages of 21and 65 years who participated in a survey administered in the Counseling African Americans to Control Hypertension clinical trial collected between 2004 and 2011. The independent variables were social support and patient-provider communication; the dependent variable was medication adherence. Descriptive, 2-way analysis of variance and hierarchical logistic regression model analyses indicated a significant association between patient-provider communication and medication adherence. There was no significant difference in the relationship between social support, patient-provider communication, and age and gender and medication adherence. The implications of this study for social change include improvement in policies and development programs to support the critical role of providers in ensuring medication adherence in hypertensive African American patients.

A hipertensão arterial é uma doença crônica, caracterizada pelo aumento constante da pressão sangüínea acima da normalidade (140 mmHg para a sistólica e 90 mmHg para a diastólica). Tem alta prevalência, em geral assintomática e é determinada por diversos fatores como raça, hereditariedade, idade e hábitos de vida relacionados à alimentação e à prática de exercícios físicos. É um dos maiores fatores de risco de morbidade e mortalidade cardiovasculares no mundo todo, causando além dos sérios problemas relativos à saúde, alto custo social. A falta de adesão às recomendações que são dadas aos pacientes é uma das causas do insucesso no tratamento dos indivíduos hipertensos, tornando-se um problema de saúde pública, encontrado em países do mundo todo. Por ser a hipertensão arterial uma doença assintomática é mais difícil motivar seu tratamento. Para isso, é fundamental a prática de uma sistemática contínua de orientação ao paciente pela equipe de saúde. O presente trabalho teve como objetivo estudar a repercussão de um programa educacional para melhorar a adesão do paciente ao tratamento. Foi aplicado pelo farmacêutico e comparado a um grupo controle, em pacientes atendidos pelo ambulatório de hipertensão do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo, através de palestras e orientação individualizada. Os resultados foram avaliados por meio de questionário, dosagens de sódio e potássio urinário, controle de pressão arterial, peso corpóreo, medidas de circunferência de cintura e quadris e de exames bioquímicos laboratoriais, entre outras variáveis. Verificou-se que os pacientes do grupo experimental apresentaram maior redução da pressão arterial sistólica e diastólica, do nível sé rico de triacil-gliceróis e da relação entre cintura/quadril, além de apresentarem aumento da excreção urinária de potássio em volume de 24 horas e da porcentagem de acertos em questionários referentes a aspectos gerais sobre hipertensão arterial, em relação aos pacientes do grupo controle. Tais resultados indicam aumento de adesão ao tratamento, mediante o processo educativo oferecido ao grupo experimental.
Hypertension is a chronic disease featured by a continuous rise in blood pressure above normal levels (140mmHg for systolic pressure and 90mmHg for diastolic pressure). A highly prevalent disease, it is not usually accompanied by symptoms and is determined by a number of factors, such as race, heredity, age, and living habits related to food intake and physical exercises. It is one of the highest risk factors for cardiovascular morbidity and mortality, thus leading not only to serious health disorders, but also to high social expenditure. Unsuccessful treatment of individuals who suffer from hypertension is in part a consequence of the fact that patients do not follow recommendations, which ultimately causes hypertension to be a public health issue throughout the world. As patients do not display any symptoms, they turn out to be less easily motivated to undergo treatment. It is therefore utterly important that health professionals provide patients with continuous, systematic guidance. This project analyzes the effects of an educational program aimed at fostering patients adhesion to medical treatment. It was carried out by a pharmacist and compared to a control group comprised by patients who sought medical assistance at the University Hospital hypertension clinic of the Medical School of the University of São Paulo, by means of lectures and private guidance. Results were assessed by means of a questionnaire, urinary potassium and sodium dosages, arterial pressure control, corporeal weight, waist and hip circumference measures, laboratory biochemical tests, among other variables. Results showed that the educational process addressed to the said experimental group was effective as to lower systolic and diastolic blood pressure, serum triacylgycerol levels and waist-hip ratio. An increase in urinary potassium excretion was also observed within a 24-hour volume, along with a greater number of correct answers to general questions about hypertension among patients in the control group. Such results are an evidence that the number of individuals who adhered to medical treatment increased as a consequence of the educational process provided for the experimental group.

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Introduction: The patients compliance as well as an adequate blood pressure control are the major challenges in the treatment of hypertension. Objective: The purpose of this study was to observe the efficacy of an education program carried out by the nurse by means of a conscious pedagogical methodology in the blood pressure control, in the treatment compliance with a non-pharmacological therapy as well as in the frequency to examinations in the hypertension service. Casuistics and Method: Two groups of hypertensive individual were studied: the control group that attended the hypertension routine service; and the study group that besides the service took part in educational activities based on Paulo Freire s pedagogical methodology carried out by the nurse. Blood pressure was indirecty measured in both groups, biweekly; the control group was let off after examinations, and the study group referred to the educational activities. These were held during 12 months, in a total of 23 meetings, and at-home visits were accomplished for both groups after 24 months of the education program starting period. Total cholesterol and fractions (HDL, LDL, VLDL), triglycerides, ghycemia, sodium-potassium at the last 24-hour urine tests were collected, quarterly. Results: It was observed that the blood pressure was around normal level in the study group; the body mass index values, tryglicerides and urine-sodium were lowered. Some changes in the non-pharmacological therapy was also observed such as: a better understanding about the disease, smoking was quitted and the frequency in physical activities. There were no significant changes in both groups in relation to ethylism and other metabolic parameters. At-home visits, the study group showed adequate blood pressure control in 95.69%, where as the control group, 34.8% (p<0.05). There was a significant difference between the two groups in relation to the frequency to the examinations in the hypertension service since no patients of the study group abandoned the follow-up, whereas 21.70% of the control group did (p<0.05). Conclusion: This education program has got the study group patients aware in relation to the treatment since it was taken seriously and better results were showed such as: adequate blood pressure control; the examination compliance in the hypertension service as well as the non-pharmacological therapy. Therefore, this study is likely to contribute to further changes in hypertensive patient s education.
O maior desafio da hipertensão arterial é a adesão dos pacientes ao tratamento e o controle da pressão arterial. Objetivo: Este estudo teve o objetivo de verificar a eficácia de um programa educativo, realizado pelo enfermeiro, empregando a metodologia pedagógica conscientizadora no controle da pressão arterial, na adesão ao tratamento não farmacológico e na assiduidade nos retornos a consulta no ambulatório de hipertensão arterial. Casuística e Método: Foram estudados dois grupos de hipertensos: o grupo controle, que participou do atendimento de rotina do ambulatório e o grupo estudo, que além dos cuidados convencionais, participou das atividades educativas realizadas pelo enfermeiro seguindo a metodologia pedagógica de Paulo Freire. Foi realizada medida indireta da pressão arterial quinzenalmente de ambos os grupos, sendo o grupo controle dispensado após verificações e o grupo estudo encaminhado para as atividades educativas. Estas ocorreram em um período de 12 meses, no total de 23 encontros, sendo que após 24 meses do início do programa educativo, foram realizadas visitas domiciliares em ambos os grupos. Foram coletadas amostras de sangue para exames de colesterol total e frações (HDL, LDL, VLDL), triglicérides, glicemia, sódio e potássio na urina de 24 horas trimestralmente. Resultados: Verificou-se que no grupo estudo a pressão arterial ficou em níveis desejáveis, com queda nos valores do Índice de Massa Corpórea, triglicerídeos e sódio urinário. Demontraram-se também, neste grupo modificações no tratamento não farmacológico, tais como: maior compreensão sobre a doença, abandono do hábito de fumar e a prática de exercício físico. Não houve modificações significativas nos dois grupos com relação ao consumo de bebida alcoólica e aos demais parâmetros metabólicos. Nas visitas domiciliares verificou-se que o grupo estudo apresentou 95,6% com a pressão arterial controlada e o grupo controle 34,8% (p< 0,05). Houve diferença significante entre os dois grupos quanto a assiduidade no ambulatório de hipertensão arterial, já que não ocorreu abandono entre os pacientes do grupo estudo, enquanto 21,7% do grupo controle abandonaram o atendimento ambulatorial (p<0.05). Conclusões: Constatou-se que o programa educativo utilizado com o grupo de estudo levou o paciente a assumir com maior seriedade o tratamento, trazendo melhores resultados no que concerne aos valores pressóricos, na assiduidade às consultas ao ambulatório de hipertensão arterial e na adesão ao tratamento não farmacológico quando comparadas ao grupo controle. Deste modo, esta pesquisa tem muito a contribuir para uma prática transformadora na educação dos hipertensos.

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Introduction: hypertension is a major public health problem. Among the difficulties of health professionals regarding this issue highlights the lack of patient adherence to treatment. The treatment and control of hypertension remain as challenges for health professionals, because compliance rates are still low. The nurse helps the patient hypertensive plan actions making the patient an active being in their treatment. Objective: to evaluate whether interventions can influence patient adherence to treatment and their perception of the disease and consequently in blood pressure control. Methods: this is a randomized clinical trial, conducted in specialized service. We identified all those who were there more than a year without attending to any query and these were considered in situations of abandonment of service. It was also calculated the rate of blood pressure control. The study variables were: socio-demographic variables, blood pressure values, number of antihypertensive use, lifestyle, risk factors for cardiovascular disease, body mass index, time since diagnosis, treatment time, and treatment time the specialized service, pharmacological treatment and knowledge, beliefs and perceptions of patients about their treatment and their disease. To assess compliance, we applied the Morisky-Green Test for both groups. For the evaluation of the knowledge, beliefs and perceptions was applied Illness Perception Questionnaire. Two groups were randomly. The study group (SG) received interventions with weekly phone calls between queries and also consultations nursing after medical consultation. The control group (CG) remained in routine follow-up. Results: In 2011, the dropout rate in service was 6.4%, and in 2012 this rate was 11.0%. The rate of blood pressure control in 2011 was 73.9% and in 2012 was 61.7%. Those who had uncontrolled pressure had more patients in situations of low adherence (64.5%) than the group of controlled hypertensive (43.3%). After the intervention, a reduction in mean systolic blood pressure was higher in the SG than in the CG. In the end, there was no individual alcoholics in GE. The difference in the reduction of membership fees was 46.6% in the EG and 27.6% GC statistically significant (p < 0.05). Those who had a higher perception of personal control over the disease had greater adherence to pharmacological treatment. Conclusion: we found a low dropout service compared to other centers. This is reflected in the high rate of BP control. Non-adherence to treatment may explain the lack of BP control. The intervention performed by nursing altered rates of adherence to treatment and BP control, and also interfered in decreased intake of alcoholic beverages occasional. The group that participated in the intervention showed better understand about the chronicity of the disease and also about its consequences.
Introdução: a hipertensão arterial é um grande problema de saúde pública e a não adesão ao tratamento pelo paciente é um dos maiores desafios dos profissionais de saúde. A enfermagem tem importante papel em todas as fases do tratamento, seja no planejamento dos serviços de assistência, seja com ações educativas, estabelecendo vínculos com o paciente, e promovendo a adesão Objetivo: Avaliar os reflexos de intervenções de enfermagem sobre a adesão ao tratamento de pacientes hipertensos com pressão arterial (PA) não controlada. Metodologia: Trata-se de um ensaio clínico randomizado, realizado em serviço especializado, com pacientes hipertensos não controlados, com idade maior ou igual a 18 anos, e que tivessem acesso telefônico. As variáveis foram: sócio-demográficas, pressão arterial, anti-hipertensivos prescritos, hábitos de vida, fatores de risco para doenças cardiovasculares, índice de massa corpórea, tempo de diagnóstico, de tratamento e de tratamento no serviço adesão ao tratamento farmacológico e conhecimentos, crenças e percepções do paciente em relação ao seu tratamento e à sua doença. Para a avaliação da adesão, foi aplicado o Teste de Morisky-Green (TMG) para ambos os grupos. Para a avaliação dos conhecimentos, crenças e percepções foi aplicado o Illness Perception Questionnaire (IPQ-R). Foi calculada uma amostra de 110 indivíduos, sendo 55 para cada grupo, grupo estudo (GE) e grupo controle (GC). A participação nos grupos foi de modo aleatório. O GE recebeu as intervenções com telefonemas semanais entre as consultas e também a realização de consultas de enfermagem após a consulta médica. O GC permaneceu em seguimento de rotina, sem intervenção. A coleta de dados foi realizada no período de janeiro/2012 a março/2013. A análise estatística foi realizada com o auxílio SPSS/PC versão 20.0. Foram utilizados os testes Qui-quadrado ou Fisher, teste de Kolmogorov teste T-student, teste de Wilcoxon; nível de significância de 0,05 e intervalo de confiança de 95%. Resultados: houve maior redução da pressão arterial sistólica média no GE. No final, não havia nenhum indivíduo alcoolista no GE. Houve redução das taxas de baixa adesão em ambos os grupos, sendo a diferença na redução no GE de 46,6% no GC de 27,6 % (p<0,05). Aqueles que tinham maior percepção do controle pessoal sobre a doença tiveram maior adesão ao tratamento farmacológico. Conclusão: A intervenção realizada pela enfermagem alterou as taxas de adesão ao tratamento e de controle da PA, e também interferiu na diminuição de ingestão de bebidas alcoólicas ocasionais. O GE mostrou entender melhor sobre a cronicidade da doença e também com relação as suas consequências.

Hypertension is a common public health problem. Lack of self-care practices and non-adherence to treatment plans are among the primary reasons for the increasing cases of the condition. The project assessed the teach-back method and the reliability of assessment tools in improving health literacy and hypertension management among adult patients with hypertension. Effective patient education is critical for the control and treatment of hypertension. A convenience sampling was used to recruit patients with hypertension (N=16) in a primary care facility. A quantitative descriptive pre and post study design ascertained the effectiveness of the teaching intervention. Participants received face-to-face teach-back educational sessions accompanied by American Heart Association’s Understanding and Controlling your High Blood Pressure. The Healthcare Effectiveness Data and Information Set (HEDIS) guideline and the Hypertension Knowledge-Level Scale (HK-LS) were valuable in measuring outcomes before and after the intervention. There was a statistically significant improvement in median HK-LS from pre-intervention (52% IQR: 36%, 66%), to post-intervention (95% IQR: 86%, 100%, Z=-3.521, p < .001). Also, 50% of the participants met the HEDIS BP guidelines of BP less than 140/90 at post-intervention whereas none had met the target pre-intervention. The findings indicate the teach-back method to be effective in improving hypertension knowledge and BP control in this population. Healthcare providers should employ an easy to understand patient educational tool to optimize patient understanding and ability to adhere to their hypertension regimen.

Healthy People 2020 identified hypertension (HTN) as a controllable risk factor to prevent cardiovascular disease and stroke. Adhering to regular antihypertensive (AHT) medications improves outcomes in patients diagnosed with HTN by controlling blood pressure, reducing hospital visits, and promoting patient wellness. Medication adherence occurs when prescribed medicine regimens are utilized by the patient as directed to manage illness or disease, as evidenced by patients receiving medications at their pharmacy. The practice-focused question for this quality improvement project asked whether implementation of health literacy tools from Million Hearts® HTN Control: Action Steps for Clinicians, increased medication adherence as evidenced by regular medication pickups by adult hypertensive patients. Additionally, this project provided an assessment to identify the patient's current health literacy level using the Newest Vital Sign. The purpose of this quality improvement project was to improve health literacy about AHT medications to increase medication adherence in adults diagnosed with HTN. The logic model allowed for communication of resources, activities, and guidance during project implementation. Data related to medication pickups from adult participants, 1 male and 4 females aged 21-76, were analyzed using descriptive statistics via percent difference pre-post program. Results showed an 80% rate of medication adherence, however increased medication adherence was not achieved. Results also revealed a knowledge deficit in 20% of participants indicating they were unaware they had been prescribed combination AHT medication to control their blood pressure, and not knowing their most recent blood pressure results, or how their specific AHT medication regimen worked at controlling their HTN needs. These findings could lead to exploring additional underlying factors that impede medication adherence such as income, medication cost, insurance cost, and transportation needs. This project supports the need for health literacy to be addressed to improve knowledge and understanding about HTN, and implied the need to address the problem of low health literacy in patients with HTN. Implications for nursing practice include health literacy tools for community-based ambulatory clinics to influence medication adherence and self-care management of adults with HTN. Positive social change was demonstrated by providing health literacy to adult HTN population to improve medication adherence thus reducing health risk.

Dissertation
The aim of this study was to determine the knowledge of persons with hypertension in a selected geographical area regarding cardiovascular risk factors in order to make recommendations for patient education. A quantitative, non-experimental, descriptive study was done in the form of a survey using a questionnaire as measuring instrument. The population was hypertensive patients from selected private medical practices in the western part of KwaZulu-Natal and the bordering eastern part of the Free State. Convenience sampling was used and 46 respondents participated in the study. Only 16 (35%) of the respondents achieved a percentage on or above the competency indicator of 50%. Respondents performed worst in questions where definitions, for example hypertension, were assessed. Recommendations for a patient education document, nursing practice and further research were made.
Health Studies
M.A. (Health Studies)

碩士
臺北醫學大學
護理學系
91
The aims of this study were to compare the effectiveness of patient education with different models and time in patients with hypertension. Subjects, newly diagnosed as hypertension, were selected from a 600-bed teaching hospital in Southern Taipei City and randomized assign to group or individual groups. Data were analyzed by descriptive statistics, Chi-square test, fisher's exact test, and paired t-test. The results demonstrated that different education models did improve patients' health knowledge, however, no significant difference was found. In comparison of the blood pressure changes, both systolic and diastolic blood pressure were significantly lower after the intervention. In terms of education time, health knowledge was not shown significant difference among 15 minutes, 30 minutes, or 45 minutes in individual groups（p=0.16、0.20 and 1.00, respectively）. But, a significant difference was found in blood pressure between before and after education (p <0.05). For the group education, health education was only shown a significant difference in 15 minutes group（p=0.04）; similarly, a significant difference was found in blood pressure changes before and after education (p <0.05). The results can be used as a reference for future hypertension patient education to improve the quality of patient care.

碩士
美和科技大學
健康照護研究所
101
Background and Purposes This study is to establish a treatment guideline and educational consensus of hypertension, diabetes mellitus and chronic renal disease, which subsequently leads to saving medical resources and improving quality of life of patients based on the viewpoint of clinician about co-morbidity. Therefore, the aims of this study including: (1) to understand the impact of doctors in different levels of medical system on the caring and educational model of these patients; (2) to understand the impact of sub-specialties of doctor on the caring and educational model of these patients. Materials and Methods This research have randomly mailed 780 questionnaires to different levels of hospitals based on the research design of cross-sectional research, which included 228 questionnaires to family doctor, metabolism, cardiovascular and nephrology doctors of 19 medical centers; 252 questionnaires to the Department of Internal Medicine of 63 regional hospitals; 300 questionnaires to 100 local hospital. It used PASW version 19.0 statistical software to perform both descript and inferential statistical technique for understanding the opinions of physicians about the implementation of co-morbidity caring and educational model. Results There were 266 questionnaires were returned (34.1%) and 253 questionnaires were evaluable as research samples. The results showed that (1) the levels of medical system have an impact on the caring and educational model of these three diseases; (2) the sub-specialties of doctors have an impact on the caring and educational model of these three diseases. Conclusions and Recommendations Most of the interviewers of this study accepted that it indeed needs to establish a guideline of caring, examinations and education for primary care doctor. It is also imperative to having a consensus with reviewer doctor for NHI to establish a guideline of follow-up and payment system. In addition, although there are existing different opinions regarding “ examination items “, “ frequency of follow-up”, “ guidelines of payment” and “ diseases” among physicians, the results of this study also have provide a common guideline of examination and physical check-up of DM, hypertension and chronic renal disease.