Document Type : Original Article(s)
Authors
1 MSc Student, Department of Community Health and Gerontological Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Nursing and Midwifery Care Research Center AND Department of Community Health and Gerontological Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences Isfahan, Iran
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
- Sanderson WC, Scherbov S, Gerland P. Probabilistic population aging. PLoS One 2017; 12(6): e0179171.
- Mills Katherine T., Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K. Global burden of hypertension: Analysis of population-based studies from 89 countries. J Hypertens 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. Salmand Iran J Ageing 2009; 4(1): 16-29.
- 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 J Cardiol 2012; 4(5): 135-47.
- 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. J Hum Hypertens 2002; 16(5): 305-12.
- Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360(14): 1418-28.
- Stokes GS. Management of hypertension in the elderly patient. Clin Interv Aging 2009; 4: 379-89.
- 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. J Hypertens 2013; 31(7): 1364-71.
- Park YH, Chang H, Kim J, Kwak JS. Patient-tailored self-management intervention for older adults with hypertension in a nursing home. J Clin Nurs 2013; 22(5-6): 710-22.
- Armstrong C. JNC8 guidelines for the management of hypertension in adults. Am Fam Physician 2014; 90(7): 503-4.
- Kim SK, Park M. Effectiveness of person-centered care on people with dementia: A systematic review and meta-analysis. Clin Interv Aging 2017; 12: 381-97.
- Shahrani A, Daryabeigi R, Shahriari M, Khosravi A. Effect of Continuous cCare model on lifestyle modification in patients with hypertension: Randomized clinical trial study. J Res Health Sci 2016; 5(7): 231-9.
- Shirani AK, Baghaei AM. The causes of failure to control hypertension in population aged over 65. J Qazvin Univ Med Sci 2005; 35(35): 8-14.
- [In Persian].
- 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 Emerg Med 2015; 15: 38.
- Parkes J, Shepperd S. Discharge planning from hospital to home. Cochrane Database Syst Rev 2000; (4): CD000313.
- 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 Geriatr 2013; 13: 70.
- Chow SK, Wong FK. A randomized controlled trial of a nurse-led case management programme for hospital-discharged older adults with co-morbidities. J Adv Nurs 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. J Res Health Sci 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 Serv Res 2011; 11: 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. Iran J Nurs Midwifery Res 2015; 20(3): 387-97.
- Hacihasanoglu R, Gozum 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. J Clin Nurs 2011; 20(5-6): 692-705.
- Solomon JA. Needs Assessment of Hypertensive Patients. Journal of Morehouse School of Medicine 2014; 20(17): 1-3.
- Chiu CW, Wong FK. Effects of 8 weeks sustained follow-up after a nurse consultation on hypertension: A randomised trial. Int J Nurs Stud 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 [Thesis]. Shiraz, Iran: Shiraz University of Medical Sciences; 2012. [In Persian].
- Mohammadi MA, Dadkhah B, Sazavar H, Mozaffari N. The effect of follow up on blood pressure control in hypertensive patients. J Ardabil Univ Med Sci 2006; 6(2): 156-62. [In Persian].
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