An Integrated Approach to Improve Hypertension Management in African Americans

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Objective: To improve blood pressure management of African Americans through culturally adapted patient education classes and improved health care delivery systems. Methods: The 3-part project was developed utilizing the Chronic Care Model’s framework for organizing and improving chronic illness care based on a proactive and planned approach. Part one consisted of physician education on the importance of timely medication titrations using the organization’s hypertension algorithm, measured through 120 chart audits. Part two was the nurse education which reinforced the importance of obtaining accurate blood pressure measurements, measured through ten monthly spot check audits over eight months. Lastly, part three included culturally adapted patient education classes of 80 patients on the importance of hypertension management with weekly follow up over four weeks to review home blood pressure readings and medication titrations as indicated, measured through pre- and post-knowledge assessments and pre- and post-blood pressure measurements. Results: Physician chart audits showed a 65% compliance with medication titrations. The nurse spot check audits revealed 87.5% compliance in performing accurate blood pressure measurements. Outcomes of the patient education classes demonstrated a 22.1% improvement in the blood pressure control rate for the physician whose patients participated and a 10% improvement in the overall clinic control rate for the target population over three months. Additionally, there was an average of 25% knowledge increase from week one to week two based on the pre- and post-knowledge assessments for all eight cohorts. There was also an average reduction of 12mmHg in systolic blood pressure and 5mmHg in diastolic blood pressure. Conclusion: Data supported the inference that using an integrated approach involving nurse and physician education and culturally tailored education classes improved hypertension management in the African American population. The DNP project provided patients with the knowledge and necessary tools to effectively manage their blood pressures at home and increase adherence to their prescribed regimen.
Submitted in partial fulfillment of the requirements for the degree Doctor of Nursing Practice
Nursing, Health Education, Public Health