HYPERTENSION MANAGEMENT INTERVENTION PROPOSAL

ABSTRACT

With the upsurge of lifestyle diseases in the 21^st century, partially owing to the largely sedentary lifestyle lived by most people in society, coupled with an increase in the intake of processed foods, there is the need to create interventions that are easy to implement so as to ensure that conventional medicine is not the sole method through which lifestyle diseases are managed. With this in mind, what follows herein is a proposal for a non-conventional method of management of High Blood Pressure, also referred to as Hypertension. The scope of this proposal is to expound on the proposed method and the effect of its implementation.

HYPERTENSION MANAGEMENT INTERVENTION PROPOSAL

In a world that is increasingly becoming reliant on technology, the medical world has not been left behind. Across the globe we see new innovations and technologies that go a long way in providing solutions to medical practitioners. One key area of interest is in management of patients with chronic diseases, which are often expensive to manage.

In light of this, I chose to focus on the management one condition in particular, hypertension. This plan seeks to embrace the use of technology in the management of hypertensive patients with focus on how to improve quality of managing the condition as well as improving the overall safety of the patient whilst considering the reduction of treatment costs. The proposed intervention is the use of telemonitoring in the management of hypertensive patients.

Telemonitoring is a telehealth strategy that allows remote data transmission of blood pressure and additional information on patients’ health status from their dwellings or from a community setting to the doctor’s office or the hospital. (Gianfranco et al 2018). Telemonitoring tries to encompass a more holistic approach to health care in the sophistication of the technology to monitor outcomes, transmit information, and promote learning that will prevent deterioration in health. Further, it includes the assessment of data in real time, and when coupled with decision-making strategies can accelerate the delivery of best practice.

Cost wise, telemonitoring is much affordable when compared to traditional visits to the physician and cost of test required each time such a visit is scheduled. As such, patients with hypertension stand to reduce the cost of treatment by a marginal figure. This will go a long way towards improving their lives from an economic point of view too.

For this plan to be successfully implemented, there is the need to have collaborations with partner who will provide the telemonitoring framework. This will include telemonitoring hardware and software that will enable this intervention to run smoothly. These partners will provide the necessary hardware and software plus training for medical practitioners and patients as well. 

This intervention will be implemented in three stages. The first stage will involve the procurement of partner who are willing to offer the relevant hardware and software required. once this partner or partners have been procured and an agreement entered into, we will proceed to run a pilot of the project with a select number of patients. This period will allow for training of the medical practitioners involved as well as the patients who will form part of the study. Once the pilot is complete, we will roll out the project on a larger scale progressively using mapped out health facilities of clinics who would be willing to adopt this intervention.

Technology to Support Proposed Plan

Information and communication technologies figure among the solutions that could help attenuate some of the problems associated with aging populations, rates of chronic illness, and shortages of health professionals, and, at the same time, facilitate service reorganization (Tremblay M. École,2008). While encouraging home self-management through self-monitoring a patient can opt to embrace technology to aid in their treatment. One such technology is telemonitoring. Telemonitoring is an application of telemedicine in which physiological and biological data are transferred from the patients’ home to the telemonitoring center to monitor patients, interpret the data, and make clinical decisions (Roine R, Ohinmaa A, & Hailey D. Assessing, 2001). 

The underlying goal is to substitute home telemonitoring for the integrated and continuous monitoring classically used to monitor patients during an episode of care. In many health care systems around the world, home telemonitoring is an integral part of a broader view of deinstitutionalization and reflects a societal orientation toward maintaining patients in their homes (‘Integration through information communication technology for home care in Canada’ 2008). 

A review study on clinical effects of home telemonitoring in the context of Diabetes, Asthma, Heart Failure and Hypertension that set to further understanding of the clinical effects associated with home telemonitoring programs in the context of chronic diseases figured that Information and communication technologies, such as telemonitoring, figure among the solutions that could help attenuate some of the problems associated with aging populations, rates of chronic illness, and shortages of health professionals, and, at the same time, facilitate service reorganization. The primary objective of this study was to update the systematic review conducted by (Paré G, Jaana M, Sicotte C, 2007); and, most importantly, provide a deeper analysis of the clinical effects associated with home telemonitoring programs. 

 In this study 62 empirical studies were analyzed. Virtually all studies involving patients with hypertension demonstrated the ability of home telemonitoring to reduce systolic and/or diastolic blood pressure (Paré G et al 2010). It was further noted that, home telemonitoring also provided for better control of blood pressure than the traditional home follow-up model Conversely, it is important to note that the same study concluded that, although home telemonitoring appears to be a promising approach to patient management, designers of future studies should consider ways to make this technology more effective as well as controlling possible mediating variables. This conclusion serves as a possible barrier to the use of this technology as it shows that somewhat inaccuracy of telemonitoring systems to give standardized readings.

In a different study, it was noted that the variation in methods and systems used in these studies make generalizability to the general hypertension population difficult. Concerns over the reliability of technology, impact on patient quality of life, longer-term utility and cost–benefit analyses all need to be investigated further if wider adoption is to occur. The study thus sought to mitigate this by developing an artificial intelligence system written in the PROforma language that contained expressions representing clinical criteria to influence and plan treatment based on the NICE guidelines to manage hypertension (Sutton DR, Taylor P, Earle K, 2006).For the study, Clinic BP data on 219 patients seen either in a nurse or a physician-led clinic were uploaded to a database, which was then subjected to the decision system in a virtual setting The results showed that, a system using artificial-intelligence system algorithms can consistently recognize the impact of CVD risk in hypertensive patients and is more likely to suggest a treatment modification than either nurses or physicians in face-to-face consultations with the patient. Use of such decision support could possibly improve outcomes, and incorporation of such evidence-based decision-making systems could further develop the High Blood Pressure Monitoring potential of telehealth.

Despite such positive results, the role of telehealth in health care delivery is still being actively debated. There are some issues related to the adoption of new technology, but what is less easy to assess is the impact the interrelationship with care providers and technology may have on health behavior. Telehealth technology could deconstruct the traditional medical model typified in the standard clinical consultation and bring care closer to patient’s homes, which may ostensibly be better for patients, there is concern over its long-term efficacy and impact on quality of life.

Further, the architecture of a typical telehealth system is complex, with many links between the components at which problems may arise, including authentication, capture, transfer, interpretation, contextualization of data, and provision of an action plan. (Sivakumaran, D., & Earle, K. A. 2014).  This poses the potential of having telemonitoring, as a means of hypertension management, adopted with caution owing to its perceived complexity. As such, even though home telemonitoring appears to be a promising approach to patient management, designers of future studies should consider ways to make this technology more effective as well as controlling possible mediating variables (Paré G et al 2010). 

Organizational An Government Policies Impact 

Prevention and management of hypertension needs the political will of policy makers and the government, in addition to efforts from the civil society, health workers, academic research community, the private sector, patients and their families. Policy makers and the government should ensure that public health policies are implemented through sustainable, affordable, and cost-effective interventions. Monitoring and surveillance systems should also be set up to monitor the prevalence of hypertension. Individuals with hypertension must be able to access unbiased precautionary, curative and rehabilitation services (World Health Organization, 2014). The government must also increase its assistance in primary care health facilities to aid in prevention of hypertension through early diagnosis and other health promotion measures that include availability of hypertension controlling medications and education on ways to prevent high blood pressure. In addition, the government has the power to strengthen all elements concerning the health system, that is, access to quality medicine even if its generic, governance, service delivery, information, financing, human resource, and basic technology (WHO, 2014).

• Identify the key stakeholders in your clinical practicum environment, including patients, with whom you plan to communicate. 

• Describe any surprising experiences you have had while enlisting support and gathering stakeholder input on needed behavioral or educational changes in this patient or population to address the identified health concern.

• Discuss the benefits of gathering stakeholder input to improve care for this patient or population. 

• Identify best-practice strategies from the literature for effective communication and collaboration to improve patient outcomes in this clinical practicum.

Strategies for Collaboration and Communication to Improve Outcomes

Collaboration among healthcare professionals is encouraged to improve patient care. In the case of hypertensive patients, collaborators can be the patient, doctor, nurse, pharmacist, a clinical nutritionist, Information Communications Technology service providers and Governments. Collaboration from a can take the form of an Electronic Health Records system, which is government approved, that is linked to the telemonitoring system in use and whose data each is referred to when handling the patient. Therefore, when the patient visits the doctor, the doctor will be able to see the medication that the patient has been taking as the record will be there as provided by the pharmacist (Renfro, Ferreri, Barber, & Foley, 2018).

Thus far, it is important to note that the potential for telemonitoring to be adopted as a means of hypertension management is huge. However, each stakeholder will be required to play their roles efficiently to ensure that this intervention is delivered effectively in order to realize positive outcomes. In so doing, there is likely to be a witnessed a general improvement in the management of hypertensive patients all to the benefit of the larger medical fraternity. 

References

Gianfranco Parati MD, PhD  Eamon Dolan MD, MRCPI, PhD  Richard J. McManus PhD, FRCGP, FRCP  Stefano Omboni MD. Home blood pressure telemonitoring in the 21st century. Retrieved from  https://doi.org/10.1111/jch.13305 

Tremblay M. École nationale d’administration publique. 2008. Analyse des impacts de la mondialisation sur la santé au Québec. Rapport 5: Enjeux et défis de la pénurie des professionnels de la santé. Retrieved From http://archives.enap.ca/bibliotheques/2008/05/030032 

Roine R, Ohinmaa A, Hailey D. Assessing telemedicine: a systematic review of the literature. CMAJ 2001 Sep 18;165(6):765-771

Canadian Home Care Association. 2008. Integration through information communication technology for home care in Canada. Retrieved from  http://www.cdnhomecare.ca/media.php?mid=1840

Paré G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 2007;14(3):269-277

Paré G, Moqadem K, Pineau G, St-Hilaire C (2010) Clinical Effects of Home Telemonitoring in the Context of Diabetes, Asthma, Heart Failure and Hypertension: A Systematic Review J Med Internet Res 2010;12(2):e21. Retrieved from https://www.jmir.org/2010/2/e21/?utm_source 

Sutton DR, Taylor P, Earle K. Evaluation of PROforma as a language for implementing medical guidelines in a practical context. BMC Med Inform Decis Mak. 2006 Apr 5; 6():20.

Sivakumaran, D., & Earle, K. A. (2014). Telemonitoring: use in the management of hypertension. Vascular health and risk management, 10, 217–224. doi:10.2147/VHRM.S36749. 

Paré G, Moqadem K, Pineau G, St-Hilaire C (2010) Clinical Effects of Home Telemonitoring in the Context of Diabetes, Asthma, Heart Failure and Hypertension: A Systematic Review J Med Internet Res 2010;12(2):e21. Retrieved from https://www.jmir.org/2010/2/e21/?utm_source 

American Medical Association. (2014, February 3). At intersection of quality and safety, improving hypertension care. 

Retrieved from https://www.ama-assn.org/delivering-care/hypertension/intersection-quality-and-safety-improving-hypertension-care 

Kitt, J., Fox, R., Tucker, K. L., & McManus, R. J. (2019). New Approaches in Hypertension Management: a Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care. Current hypertension reports, 21(6), 44. doi:10.1007/s11906-019-0949-4

Mayo Clinic. (2019, January 9). 10 drug-free ways to control high blood pressure.

 Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974 

Renfro, C. P., Ferreri, S., Barber, T. G., & Foley, S. (2018). Development of a Communication Strategy to Increase Interprofessional Collaboration in the Outpatient Setting. Pharmacy (Basel, Switzerland), 6(1), 4. doi:10.3390/pharmacy6010004

World Health Organization. (2014, April 4). High blood pressure: everyone has a role | World Health Day 2013 | World Health Days. Retrieved from http://www.emro.who.int/media/world-health-day/partners-factsheet-2013.html