Evaluation of a specialist nurse-led hypertension clinic with consultant backup in two inner city general practices: randomized controlled trial

Dean, Sally C; Kerry, Sally; Khong, Teck K; Kerry, Sally; Oakeshott, Pippa

doi:10.1093/fampra/cmt074

Cited by 13 publications

(38 citation statements)

References 15 publications

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“…Two UK research studies on specialist clinics published from 2010 onwards were identified from the mapping review. 219,220 One of the clinics was for patients with hypertension 219 and one was for high-risk respiratory patients with COPD or asthma. 220 The research studies were both quantitative: one was a RCT 219 and the other was an uncontrolled observational study.…”

Section: Number and Type Of Uk Studies Identifiedmentioning

confidence: 99%

“…219,220 One of the clinics was for patients with hypertension 219 and one was for high-risk respiratory patients with COPD or asthma. 220 The research studies were both quantitative: one was a RCT 219 and the other was an uncontrolled observational study. 220 A summary table of the included studies is provided (see Appendix 4, Table 31).…”

Section: Number and Type Of Uk Studies Identifiedmentioning

confidence: 99%

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Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis

Chambers

Cantrell

2020

Health Serv Deliv Res

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Background In 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice. Objectives To map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions. Methods For the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA). Results A total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights. Limitations The research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders. Conclusions Overall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services. Future work Research should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Section: Number and Type Of Uk Studies Identifiedmentioning

confidence: 99%

Section: Number and Type Of Uk Studies Identifiedmentioning

confidence: 99%

Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis

Chambers

Cantrell

2020

Health Serv Deliv Res

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“…14 MI has been associated with decreases in SBP by 4mmHg and DBP by 3mmHg as compared to usual care in randomized control trials. 14,15 MI has also been associated with long term changes over greater than one year. 16 Interviews of patients demonstrated that staff trained in MI were more engaged in encounters, and patients felt guided and motivated rather than directed.…”

Section: Evidence For the Problemmentioning

confidence: 99%

“…13 However, studies using registered nurses have also demonstrated decreased blood pressure in patients. 14,15,19 Other studies using medical assistants (MA) or layperson health coaches have shown promise. While the use of MA-driven protocols have not been associated with improvements in blood pressure, improvements in other health outcomes such as reduced hemoglobin A1C to 8.0% or normal low-density lipoprotein levels have been shown.…”

Section: Evidence For the Problemmentioning

confidence: 99%

“…Evidence does suggest that use of staff RNs and/or MAs can effectively help patients keep blood pressure under control. 15,19,20,24 MAs may become resistant to this program due to the added workload. A timed study involving a MA-based program for promoting health behavior found that an average of 5.4 minutes per patient was added to the workload.…”

Section: Barriers/resistancementioning

confidence: 99%

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Effects of Hypertension Education and Motivation Interviewing by Staff on Patients' Activation

Lu¹,

James²,

Wolfgang³

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Objective: This evidence-based practice project piloted a team-based program using Motivational Interviewing (MI) and 5 A's (Assess, Advise, Ask, Assist, and Arrange) to promote healthy behavior and reduce blood pressure at an on-site corporate primary care clinic. Methods:Patients were counseled using MI and the 5 A's techniques. Patients received an educational booklet, and monthly telephone follow up. Patients returned to clinic 3 months afterwards. Data collected included Dietary Screener Questionnaire scores, blood pressure, and self-rating of concern and motivation. Results:A total of 4 people participated with variable follow-up. Readiness for change remained stable and confidence scores remained stable or increased. One patient decreased daily amount of fatty, salty and sugary foods, but also of desirable food. In 3 of the 4 patients, blood pressure readings improved or remained the same. Conclusion and Implications:Use of MI may contribute to a patient friendly environment to encourage healthy behavior.

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Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care

Weeks

George

MacLure

et al. 2016

Cochrane Database of Systematic Reviews

140

151

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Evaluation of a specialist nurse-led hypertension clinic with consultant backup in two inner city general practices: randomized controlled trial

Abstract: Invitation to a specialist nurse-led hypertension clinic with consultant back up was associated with reduced systolic blood pressure.

Cited by 13 publications

References 15 publications

Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis

Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis

Effects of Hypertension Education and Motivation Interviewing by Staff on Patients' Activation

Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care

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