Critical Appraisal Research

Critical Appraisal Research

Hypertension is a health condition that requires sustained treatment. The health costs associated with the treatment of hypertension are both direct and indirect. The direct medical costs are the expenses incurred in the purchase of medical products used to prevent or treat an illness. Some of the direct costs include inpatient stays, laboratory tests, prescription medications, physician visits, and home health care. The direct health costs of hypertension are of two types; hypertension treatment costs and expenses of comorbidities linked to hypertension. The indirect costs burden lies mostly on the public, and thus they are higher than the direct costs.

Various trend analysis has shown that the inpatient medical costs for people with hypertension are reducing while at the same time, the home-based costs are increasing. This is a reflection of the reduced hospitalization rates; fewer procedures decreased readmissions and the adoption of the Dash diet among patients. The trend also signals the improvements made in the diagnosis of hypertension and its treatment (Kar et al., 2018). The Affordable Care Act has increased hypertension screening by improving access to health care services. Screening has reduced individual medical costs while at the same time, increased the societal costs because of the increased treatment..

The rising healthcare costs are a result of many factors. The occurrence of hypertension is increasing steadily worldwide, which can be attributed to adults being diagnosed at an older age when the condition has worsened. Government healthcare expenditures increase when the occurrence increases. Additionally, adults infected with hypertension and under treatment tend to live longer than those who were diagnosed late. Adults living with hypertension are at a high risk of being diagnosed with other forms of comorbid illness, such as renal disease (Zhang et al., 2017). The comorbid illness increases the medical expenditures, burdening the government to adjust its budget to accommodate the treatment of such illness. Treatment of hypertension for adults with 65 years and above is higher compared to the cost incurred in treating adults aged 18 to 45 years. This is because the risk of hypertension-related illness is higher to adults aged 65 years and above than the younger one and pay more for their treatment. This is the reason why most of them take antihypertensive drugs.

The annual expenditure for patients with hypertension is almost double compared to those people without hypertension. Increasing public education on lifestyle modification to reduce blood pressure with time may lead to lower drug costs and fewer doctor visits. Sex and age of the person dictate partly the risk of being infected with hypertension and the related illness (Alcocer & Cueto 2008). Medical expenses per individual are higher in women when compared to men. Women respond to the treatment better than men even though they are more prone to experience comorbid diseases such as stroke resulting in high total costs in the treatment.

Direct costs in the treatment of hypertension in women are higher than men because most of them stay at home and seek medical care from there, incurring costs. Most of the adults aged 65 years and above have retired and have no strong source of income, making it harder for them to receive treatment because of the high costs associated. The increased cost may make some of the patients to stop the antihypertensive medication, especially those who do not have insurance cover for the drugs. This makes them vulnerable to heart disease and stroke.

Families with patients suffering from hypertension also incur costs in taking care of them. Most of the adults aged 65 and above are in no position to follow the prescribed medications and need a helper for direction, and thus a family member sacrifices his time to take care of the patient (Wang et al., 2017). Other families have to pay for a nurse to frequently check their patients at home, which is more costly when one visits a hospital. Families have to limit their money used for the sake of treating one of their family members and thus acts as a burden on them in the long run.

APRN’s Role in Hypertension Treatment

The Advanced Practice Registered Nurses perform various roles in the management of hypertension, including detection and follow up, diagnosis and medication management, counseling and patient education, management of the clinic, and coordinating patients care.

Detection and Follow Up

Nurses measure blood pressure in most of the health centers using best practices as required by the medical fraternity to each patient. Additionally, the nurses lead and coordinate blood pressure screening initiatives in schools, churches, and other places. The measured blood pressure is analyzed by the nurse to determine if it is in the normal range or not. There are tools that the nurses use to recognize uncontrolled hypertension and treat it. The nurses follow up their patients through telephone, mail, and other digital platforms about their health status, and this improves the nurse-patient relationship. Nurses are the first medical professionals who detect hypertension and thus play a key role in enforcing treatment guidelines.

Diagnosis and Medication Management

The nurses are responsible for diagnosing and management of hypertension. The registered nurses prescribe medications according to the national treatment rules to achieve the required blood pressure control. Patients under the care of nurses have shown greater response to blood pressure control than those under standard care (Himmelfarb et al., 2016). The outcomes are a result of the nurses offering medications to many patients and altering drug routines in response to blood control. Nurses also have been taught how to manage other related illnesses such as diabetes apart from the knowledge they have on hypertension management.

Patient Education and Counselling

Nurses educate and offer counseling services in most of the hypertension care places to ensure patients are following good lifestyles that will positively influence their blood pressure. They use effective strategies to improve blood pressure control, such as teaching the patients how to monitor their blood pressure level and the best ways to control it (Himmelfarb et al., 2016). The goal of teaching the patients is to make them have the necessary skills to maintain their blood pressure.

Management of the Clinic

Nurses coordinate other team members working in the hypertension clinic to achieve quality in the provision of treatment. The nurses also have the responsibility of hiring and training community health workers to measure blood pressure, arrange for appointments, collect laboratory results, and entry of data. The nurses influence how resources are to be used, such as the required length of clinic visits.

Coordinating Patients Care

Maintaining a hypertension control involves monitoring the blood pressure continually, refilling prescriptions, providing counseling, and enforcing behavior change. Every individual patient’s management is separated while minimizing costs. The nurses build and maintain linkages between different providers and services. Furthermore, the nurses help patients to understand the treatment schedule and explain to them the complex health systems.

Foundation of PICOT

Hypertension creates other health complications such as stroke and kidney failure, and its management involves paying attention to diets and exercising. A sample size of 5014 participants was used, comprising of countries, age groups, and gender. A 95% confidence interval was used, which showed a remarkable reduction in the blood pressure through proper healthy meal plans. The study focused on blood pressure measurements after each clinical visit. The follow up on the benefits of dietary interventions to hypertension patients was unsuccessful as it lasted between 6 weeks to 2 years, which is a shorter period compared to the required one of 7 years. According to the existing literature, four dietary plans reduce hypertension in patients, namely, the Dietary Approaches to Stop Hypertension (DASH), Nordic diet, Mediterranean diet, and the Tibetan diet. Study findings showed that a healthy nutritional plan reduces both systolic and diastolic hypertension. Physicians must consider all aspects before implementing any treatment plan to patients because an average American may not be in a position to afford the blueberries because of their high cost. Healthcare costs in hypertension treatment are more expensive in adults aged 65 years and above than those aged between 18 to 45 years. Governments have to make a reservation budget for the ever-increasing hypertension cases and the related illness such as stroke. Apart from being a burden on the patient in treating hypertension, the family also feels the weight of directing almost all their money to cater to the treatment of their member. APRN performs various roles in hypertension management, namely, detection and follows up, diagnosis and medication management, counseling and patient education, management of the clinic, and coordinating patients care. These evidences have led to the formation of PICOT question, Will use of Exercise and Dash Diet among Adult patient in a community church diagnosed with hypertension and taking medication help to reduce hypertension over a period of three months?

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References

Alcocer, L., & Cueto, L. (2008). Hypertension, a Health Economics Perspective. Therapeutic Advances in Cardiovascular Disease, 2(3), 147-155.

Himmelfarb, C. R. D., Commodore-Mensah, Y., & Hill, M. N. (2016). Expanding the Role of Nurses to Improve Hypertension Care and Control Globally. Annals of Global Health, 82(2), 243-253.

Kar, S. S., Kalidoss, V. K., Vasudevan, U., & Goenka, S. (2018). Cost of Care for Hypertension in a Selected Health Center of Urban Puducherry: An Exploratory Cost-Of-Illness Study. International Journal of Noncommunicable Diseases, 3(3), 98.

Wang, G., Grosse, S. D., & Schooley, M. W. (2017). Conducting Research on the Economics of Hypertension to Improve Cardiovascular Health. American Journal of Preventive Medicine, 53(6), S115-S117.

Zhang, D., Wang, G., Zhang, P., Fang, J., & Ayala, C. (2017). Medical Expenditures Associated With Hypertension In The US, 2000–2013. American Journal of Preventive Medicine, 53(6), S164-S171.