Storied experiences of nurse practitioners managing prehypertension in primary care

Hernandez, Johnanna; Anderson, Stoerm

doi:10.1111/j.1745-7599.2011.00663.x

Cited by 19 publications

(32 citation statements)

References 15 publications

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“…Skills barriers mainly included difficulty in keeping up with new clinical information [20], educating and counselling patients [22] and addressing prehypertension [23].…”

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

“…Providers described their reluctance to initiate treatment for ‘someone else's patient’ despite repeated recording of high BPs [21]. Poor coordination between different general practices and lack of consensus in standardization of measurements were also reported [20], [23], [27]. Problems with Priority setting may sometimes prevent better HT control.…”

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

“…Health system barriers were the most commonly reported barriers among providers. Those relating to Availability of health care resources included lack of consultation time [22], [23] which may impair the ability to follow guidelines, resulting in poor BP control. Lack of space, equipment, and shortage of staff were also reported [22].…”

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

“…Providers also reported difficulties in locating guidance on delivering care [21], [22]. Affordability barriers included insufficient financial reimbursement or incentives to apply recommended HT care [21], [23], [24], [26], [27]. None of the providers reported any barriers regarding providers' acceptability of health care or medications.…”

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

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Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

et al. 2014

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BackgroundAlthough the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers.MethodsElectronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints.FindingsTwenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers.ConclusionsThis review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions. More methodologically rigorous studies that encompass the range of barriers and that include low- and middle-income countries are required in order to inform policies to improve hypertension control.

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“…Skills barriers mainly included difficulty in keeping up with new clinical information [20], educating and counselling patients [22] and addressing prehypertension [23].…”

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

Section: Results Of Individual Studies and Synthesis Of Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

et al. 2014

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“…From the PC professionals' point of view, the attitudes and behavior towards PP&HP of patients [9], [23]–[29], [31]–[52], [54], [55], specialists [34], [43], [44], practice managers [23], [28], [35], [39], [51] and colleagues [23], [26], [36], [37], [39], [43], [54] affect the feasibility of implementing PP&HP in PC.…”

Section: Resultsmentioning

confidence: 99%

Barriers and Facilitators for the Implementation of Primary Prevention and Health Promotion Activities in Primary Care: A Synthesis through Meta-Ethnography

et al. 2014

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BackgroundEvidence supports the implementation of primary prevention and health promotion (PP&HP) activities but primary care (PC) professionals show resistance to implementing these activities. The aim was to synthesize the available qualitative research on barriers and facilitators identified by PC physicians and nurses in the implementation of PP&HP in adults.Methods and FindingsA systematic search of three databases was conducted and supported by manual searches. The 35 articles included were translated into each other and a new interpretation of the concepts extracted was generated. The factors affecting the implementation of PP&HP activities in PC according to professionals were fitted into a five-level ecological model: intrapersonal factors, interpersonal processes, institutional factors, community factors and public policy. At the intrapersonal level we find professionals' beliefs about PP&HP, experiences, skills and knowledge, and selfconcept. The attitudes and behavior towards PP&HP of patients, specialists, practice managers and colleagues (interpersonal factors) affect the feasibility of implementing PP&HP. Institutional level: PC is perceived as well-placed to implement PP&HP but workload, lack of time and referral resources, and the predominance of the biomedical model (which prioritizes disease treatment) hamper the implementation of PP&HP. The effectiveness of financial incentives and tools such as guidelines and alarms/reminders is conditioned by professionals' attitudes to them. Community factors include patients' social and cultural characteristics (religion, financial resources, etc.), local referral resources, mass-media messages and pharmaceutical industry campaigns, and the importance given to PP&HP in the curriculum in university. Finally, policies affect the distribution of resources, thus affecting the implementation of PP&HP.ConclusionsResearch on barriers and facilitators in the implementation of PP&HP activities in multirisk management is scarce. The conceptual overview provided by this synthesis resulted in the development of practical recommendations for the design of PP&HP in PC. However, the effectiveness of these recommendations needs to be demonstrated.

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Improving Health Promotion and Disease Prevention in NP-Delivered Primary Care

Thomas¹,

Hart²,

Burman³

2014

The Journal for Nurse Practitioners

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Storied experiences of nurse practitioners managing prehypertension in primary care

Abstract: This study revealed that caring for prehypertensive patients is a complex and multilayered experience.

Cited by 19 publications

References 15 publications

Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies

Barriers and Facilitators for the Implementation of Primary Prevention and Health Promotion Activities in Primary Care: A Synthesis through Meta-Ethnography

Improving Health Promotion and Disease Prevention in NP-Delivered Primary Care

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