Vol 15, No 2 (2019): Incomplete Issue:44-52

Effectiveness of a self-care education program on hypertension management in older adults discharged from cardiac-internal wards

Fatemeh Farahmand, Parvaneh Khorasani, Mohsen Shahriari



DOI: http://dx.doi.org/10.22122/arya.v15i2.1787

Abstract


BACKGROUND: The aim of the present study was to determine the effectiveness of a self-care education (SCE) discharge program with telephone follow-ups in managing hypertension (HTN) in older patients.

METHODS: The study was conducted on 56 older patients with HTN who had recently been discharged from the cardiac wards of hospitals in Isfahan, Iran, in 2017. Participants were randomly allocated to the intervention and control groups. The intervention was a 60-minute SCE discharge program with 4 re-educative telephone follow-ups every 2 weeks based on 4 chapters of the designed SCE program and booklet. After coding the data and entering them into SPSS software, data were analyzed for the comparison of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) as well as frequency of managed HTN in the intervention and control groups at baseline (before discharge), and 2 and 3 months after discharge.

RESULTS: Statistical tests showed no significant difference in any of the demographic and confounding variables as well as baseline BPs (P > 0.050), but at post-intervention follow-ups, after Mauchly's sphericity test, repeated measurements ANOVA showed that the effect of time (P < 0.001) and group (P = 0.043) on SBP was significant. The effect of time (P = 0.036) and group (P = 0.047) on DBP was also significant. McNemar’s test showed that the frequency of managed HTN (normal BP), 3 months after discharge, was significantly higher in the intervention group compared to the control group [87.5% (n = 21) vs. 23.1% (n = 6), respectively] (P < 0.001).

CONCLUSION: SCE discharge program with telephone re-educative follow-ups was effective in reducing mean BP. The use of this program as a discharged plan for older adults with HTN and comparison of readmission rates for a longer period are recommended.


Keywords


Elderly; Discharge Planning; Hypertension; Patient Education; Self-Care; Telenursing

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References


Sanderson WC, Scherbov S, Gerland P. Probabilistic population aging. PloS one. 2017;12(6):e0179171.

Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global burden of hypertension: Analysis of population-based studies from 89 countries. Journal of Hypertension. 2015;33:e2.

Sharifi F, Mirarefin M, Fakhrzadeh H, Saadat S, Ghaderpanahi M, Badamchizade Z, et al. Prevalence of hypertension and diabetes in elderly residents of Kahrizak. Iranian Journal of Ageing. 2009;4(1):0-.

Santulli G. Epidemiology of cardiovascular disease in the 21st century: updated numbers and updated facts. J Cardiovasc Dis. 2013;1(1):1-2.

Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World journal of cardiology. 2012;4(5):135.

Azizi F, Ghanbarian A, Madjid M, Rahmani M. Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999–2000. Journal of human hypertension. 2002;16(5):305.

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine. 2009;360(14):1418-28.

Stokes GS. Management of hypertension in the elderly patient. Clinical interventions in aging. 2009;4:379.

Malekzadeh MM, Etemadi A, Kamangar F, Khademi H, Golozar A, Islami F, et al. Prevalence, awareness and risk factors of hypertension in a large cohort of Iranian adult population. Journal of hypertension. 2013;31(7):1364.

Park YH, Chang H, Kim J, Kwak JS. Patient‐tailored self‐management intervention for older adults with hypertension in a nursing home. Journal of clinical nursing. 2013;22(5-6):710-22.

Armstrong C, Committee JN. JNC8 guidelines for the management of hypertension in adults. American family physician. 2014;90(7):503.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama. 2014;311(5):507-20.

Jafari F, Shahriari M, Sabouhi F, Farsani AK, Babadi ME. Effects of a Lifestyle Modification Program on Knowledge, Attitude and Practice of Hypertensive Patients with Angioplasty: A Randomized Controlled Clinical Trial. International journal of community based nursing and midwifery. 2016;4(4):286.

Kim SK, Park M. Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clinical interventions in aging. 2017;12:381.

Shahrani A, Daryabeigi R, Shahriari M, Khosravi A. Effect of Continuous Care model on lifestyle modification in patients with hypertension: Randomized clinical trial study. International Journal of Medical Research & Health Sciences. 2016;5:231-9.

Shirani AKRAS, Baghaei A. The causes of failure to control hypertension in population aged over 65. 2005.

Gleason-Comstock J, Streater A, Ager J, Goodman A, Brody A, Kivell L, et al. Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol. BMC emergency medicine. 2015;15(1):38.

Parkes J, Shepperd S. Discharge planning from hospital to home. Cochrane Database Syst Rev. 2000;4(2):245-53.

Fox MT, Persaud M, Maimets I, Brooks D, O’Brien K, Tregunno D. Effectiveness of early discharge planning in acutely ill or injured hospitalized older adults: a systematic review and meta-analysis. BMC geriatrics. 2013;13(1):70.

Chow SKY, Wong FKY. A randomized controlled trial of a nurse‐led case management programme for hospital‐discharged older adults with co‐morbidities. Journal of advanced nursing. 2014;70(10):2257-71.

Kazem S, Shahriari M, Eghbali M. Comparing the effects of two methods of self-monitoring and telenursing on the blood pressure of patients with hypertension. International Journal of Medical Research &Health Sciences. 2016;5:213-22.

Courtney MD, Edwards HE, Chang AM, Parker AW, Finlayson K, Hamilton K. A randomised controlled trial to prevent hospital readmissions and loss of functional ability in high risk older adults: a study protocol. BMC health services research. 2011;11(1):202.

Khorasani P, Rassouli M, Parvizy S, Zagheri-Tafreshi M, Nasr-Esfahani M. Nurse-led action research project for expanding nurses’ role in patient education in Iran: Process, structure, and outcomes. Iranian journal of nursing and midwifery research. 2015;20(3):387.

Hacihasanoğlu R, Gözüm S. The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting. Journal of clinical nursing. 2011;20(5‐6):692-705.

Solomon J. Needs Assessment of Hypertensive Patients. Journal of Morehouse School of Medicine. 2014;20(17):1-3.

Chiu CW, Wong FKY. Effects of 8 weeks sustained follow-up after a nurse consultation on hypertension: a randomised trial. International journal of nursing studies. 2010;47(11):1374-82.

Faraji M. The effect of sustained nursing consult by telephone (telenursing). on adherence to self- care and blood pressure in hypertensive patient referring to cardiovascular clinic affiliated shiraz university of medical science. Shiraz: Shiraz university of medical science; 2012.

Mohammadi MA, Dadkhah B, Sezavar S, Mozafari N. The effect of follow up on blood pressure control in hypertensive patients. 2006.


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