Nurse‐led interventions to manage hypertension in general practice: A systematic review and meta‐analysis

Stephen, Catherine; Halcomb, Elizabeth; Fernandez, Ritin; McInnes, Susan; Batterham, Marijka; Zwar, Nicholas

doi:10.1111/jan.15159

Cited by 24 publications

(16 citation statements)

References 44 publications

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“…In our meta‐analysis, nurse‐led DHIs reduced systolic blood pressure by 6.49 mmHg and diastolic blood pressure by 3.30 mmHg, compared with usual care. This was in line with previous meta‐analysis findings reporting that nurse‐led interventions, including both in‐person and remote strategies for hypertension patients, effectively reduced blood pressure (Stephen et al, 2022). It is worth mentioning that a reduction in systolic blood pressure of ≥5 mmHg and diastolic blood pressure of ≥2 mmHg can reduce the risk of stroke by 7% and 11.5%, respectively (Reboldi et al, 2011; Stamler et al, 1989).…”

Section: Discussionsupporting

confidence: 91%

The effect of nurse‐led digital health interventions on blood pressure control for people with hypertension: A systematic review and meta‐analysis

Hwang

Chang

2023

J of Nursing Scholarship

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PurposeNurse‐led digital health interventions (DHIs) for people with chronic disease are increasing. However, the effect of nurse‐led DHIs on blood pressure control and hypertension self‐management remains unclear. This study aimed to identify the characteristics of nurse‐led DHIs for people with hypertension and compared the effect size of nurse‐led DHIs with that of usual care to establish evidence for the development of effective nursing interventions using technologies.DesignSystematic review and meta‐analysis.MethodsThis systematic review and meta‐analysis followed the Preferred Reporting Items for Systematic Reviews of Intervention (PRISMA) guidelines and registered the protocol in PROSPERO. Studies published from 2000 to August 5, 2021, were searched using the international databases: PubMed; Embase; Cochrane Central Register of Controlled Trials; Web of Science; CINAHL; Korean databases: RISS, KISS, KMBASE; and NDSL. Risk of bias 2.0 was used for evaluating the quality of studies. The primary outcome was blood pressure control. The secondary outcomes were self‐management, medication adherence, and diet adherence. Publication bias was assessed using the funnel plot and Egger's regression tests.FindingsThe systematic review included 26 studies. A meta‐analysis of 21 studies was conducted to calculate the effect size and identify heterogeneity among the included studies. In our meta‐analysis, we observed that nurse‐led DHIs reduced systolic blood pressure by 6.49 mmHg (95% confidence interval [CI]: −8.52 to −4.46, I2 = 75.4%, p < 0.05) and diastolic blood pressure by 3.30 mmHg (95% CI: −4.58 to −2.01, I2 = 70.3%, p < 0.05) when compared with usual care. Concerning secondary outcomes, the effect size on self‐management, medication adherence, and diet adherence was 0.98 (95% CI: 0.58 to 1.37, I2 = 63.2%, p < 0.05), 1.05 (95% CI: 0.41 to 1.69, I2 = 92.5%, p < 0.05), and 0.80 (95% CI: 0.17 to 1.42, I2 = 80.5%, p < 0.05), respectively.ConclusionNurse‐led DHIs were more effective in reducing blood pressure and enhancing self‐management than usual care among people with hypertension. Therefore, as new technologies are being rapidly developed and applied in healthcare systems, further studies and policy support are needed to utilize the latest digital innovations with nursing interventions.Clinical relevanceThis study could be used to identify that nurse‐led interventions may take advantage of real‐time communication by employing digital technologies for improving blood control and self‐management behaviors such as medication adherence and diet adherence. Using nurse‐led DHIs allows nurses to provide patient‐centered interventions such as reflecting on patients' needs and shared decision‐making without space constraints and limited treatment time.

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Section: Discussionsupporting

confidence: 91%

The effect of nurse‐led digital health interventions on blood pressure control for people with hypertension: A systematic review and meta‐analysis

Hwang

Chang

2023

J of Nursing Scholarship

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“…As Desborough et al ( 2018 ) and James et al ( 2018 ) recommend, issues related to GPNs' role and training, time, funding and organizational support must be addressed to optimize future clinical practice about lifestyle risk reduction. Despite the reported acceptability and effectiveness of nurse‐led lifestyle risk reduction, evidence remains unclear and research elucidating the successful elements of such interventions is needed (Stephen et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review

Morris

Halcomb

Mansourian

et al. 2022

Journal of Advanced Nursing

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Aim: To review the literature exploring how general practice nurses support lifestyle risk reduction. Design: Integrative literature review. Sources: CINAHL, Emcare, MEDLINE, Proquest and Scopus were searched for peerreviewed primary research published in English from 2010 to 2022. Methods: Sixteen papers met the inclusion criteria and were assessed for methodological quality using the Mixed Methods Appraisal Tool. Findings were extracted and thematically analysed. Results: Four themes described general practice nurses: (1) Establishing relational connections; (2) Empowering active participation; (3) Engaging mutual motivation and (4) Enabling confident action. General practice nurses used complex interpersonal, risk communication and health coaching skills to build collaborative partnerships that supported patients' self-determination and self-efficacy. While mutual motivation and confidence were reciprocally enabling, gaps in skills, experience and knowledge plus time, resource and role constraints limited general practice nurses' ability to support lifestyle risk reduction. Conclusion: General practice nurses play a key role in lifestyle risk reduction. Ongoing education, funding, organizational and professional support are needed to enhance their commitment, confidence and capacity.

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“…For example, low-resource interventions such as treatment intensification [ 56 ] may be feasible for smaller practices. In contrast, resource-intensive interventions, for example, those delivered by nurses [ 57 ], may not be feasible for small practices. Primary Health Networks, independent organisations that coordinate primary healthcare in a region, could support the implementation of more resource-intensive facilitation-based interventions across multiple practices, improving the cost effectiveness through economies of scale [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

The Cost of Uncontrolled Blood Pressure in Australian General Practice: A Modelling Study Using Electronic Health Records (MedicineInsight)

Roseleur

Gonzalez-Chica²,

Harvey³

et al. 2023

PharmacoEconomics

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Background Hypertension is the most common condition seen in Australian general practice. Despite hypertension being amenable to lifestyle modifications and pharmacological treatment, only around half of these patients have controlled blood pressure levels (< 140/90 mmHg), placing them at an increased risk of cardiovascular disease. Objective We aimed to estimate the health and acute hospitalisation costs of uncontrolled hypertension among patients attending general practice. Methods We used population data and electronic health records from 634,000 patients aged 45–74 years who regularly attended an Australian general practice between 2016 and 2018 (MedicineInsight database). An existing worksheet-based costing model was adapted to calculate the potential cost savings for acute hospitalisation of primary cardiovascular disease events by reducing the risk of a cardiovascular event over the next 5 years through improved systolic blood pressure control. The model estimated the number of expected cardiovascular disease events and associated acute hospital costs under current levels of systolic blood pressure and compared this estimate with the expected number of cardiovascular disease events and costs under different levels of systolic blood pressure control. Results The model estimated that across all Australians aged 45–74 years who visit their general practitioner ( n = 8.67 million), 261,858 cardiovascular disease events can be expected over the next 5 years at current systolic blood pressure levels (mean 137.8 mmHg, standard deviation = 12.3 mmHg), with a cost of AUD$1813 million (in 2019–20). By reducing the systolic blood pressure of all patients with a systolic blood pressure greater than 139 mmHg to 139 mmHg, 25,845 cardiovascular disease events could be avoided with an associated reduction in acute hospital costs of AUD$179 million. If systolic blood pressure is lowered further to 129 mmHg for all those with systolic blood pressure greater than 129 mmHg, 56,169 cardiovascular disease events could be avoided with potential cost savings of AUD$389 million. Sensitivity analyses indicate that potential cost savings range from AUD$46 million to AUD$1406 million and AUD$117 million to AUD$2009 million for the two scenarios, respectively. Cost savings by practice range from AUD$16,479 for small practices to AUD$82,493 for large practices. Conclusions The aggregate cost effects of poor blood pressure control in primary care are high, but cost implications at the individual practice level are modest. The potential cost savings improve the potential to design cost-effective interventions, but such interventions may be best targeted at a population level rather than at individual practices. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40273-02...

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Nurse‐led interventions to manage hypertension in general practice: A systematic review and meta‐analysis

Cited by 24 publications

References 44 publications

The effect of nurse‐led digital health interventions on blood pressure control for people with hypertension: A systematic review and meta‐analysis

The effect of nurse‐led digital health interventions on blood pressure control for people with hypertension: A systematic review and meta‐analysis

Understanding how general practice nurses support adult lifestyle risk reduction: An integrative review

The Cost of Uncontrolled Blood Pressure in Australian General Practice: A Modelling Study Using Electronic Health Records (MedicineInsight)

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