Hypertension: A Socio-Economic Challenge in Modern Times

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Table of Contents

Introduction
Revision & Synthesis
Proposed Evidence-Based Quality & Safety Program
Potential Obstacles & Solutions for Overcoming
Stakeholders
Change Management Theory
Expected Outcomes
Conclusion
References

Introduction

Hypertension is a huge socio-economic problem in the modern world. It occupies a leading place in the structure of mortality and disability in economically developed countries, as well as in developing countries. In Europe, about 3 million people die from hypertension every year, and in the USA, there are about 1 million of patients with this illness (ihi.org, 2017). Hypertension affects people of working age, which influences the economic and social condition of the country. In connection with the current situation, the purpose of this paper is to analyze the system of prevention and treatment of hypertension both at the state level and at the level of the practical health service. Quality and sustainability changes in the field of cardiology will have a beneficial effect not only on the treatment of patients with pre-existing pathology, but also on the early detection of healthy patients with one or more risk factors and on the planning of preventive measures aimed at their elimination.

Revision & Synthesis

In the first part of the study, the main types of hypertensions were identified, as well as the currently existing quality and safety measures. Among the concepts already used, one can single out the idea of three barriers and three facilitators. The issues of virtual medicine are touched upon, the topic of which will also be continued in this work. Further in Part 1 it is dwelled on the development of preventive measures to maintain heart health. The concept of prevention of hypertension is also key in the second part of the work. Its main ideas are promoting physical activity and assessing risk factors, which will be integrated into the proposed evidence-based and safety program.

Proposed Evidence-Based Quality & Safety Program

The concept of risk factors, developed in the 60s, has become the scientific basis for the prevention of diseases of the circulatory system (ihi.org, 2017). With the accumulation of scientific data, the concept of risk factors has developed and to date has been supplemented with the following provisions, which are actively used in quality and safety programs (Kleinpell, 2021). Risk began to be considered as a continuous characteristic, and quantitative methods for assessing individual risk and risk stratification were created. The concept of risk implies the active promotion of physical activity to prevent hypertension. A systematic review of the results of clinical studies indicates that by changing the lifestyle, it is possible to significantly reduce the mortality from diseases of the circulatory system both in patients and in the general population (Barone Gibbs et al., 2021). Strengthening preventive activity in healthcare related to promoting and encouraging the desire of the population for a healthy lifestyle is also an important component of the quality and safety program.

It is clinically proven that the evidence-based quality and safety program to address the issue from Part 1 (hypertension) significantly increases the positive outcome for patients. The main risk factors assessed in the first part of the program are smoking and drinking alcohol and fatty foods, as well as a sedentary lifestyle (Brantley & Chipps, 2021). When risk factors are eliminated, according to the second part of the evidence-based quality and safety program, the number of deaths decreases (Brantley & Chipps, 2021). When patients quit smoking, the negative outcome possibility falls by 50%, with sufficient physical activity — by 30%, with moderate alcohol intake — by 15%, and with a change in diet — by 40% (Carey et al., 2018).

My proposed design is to digitalize the assessment of risk factors and promote a healthy lifestyle. It has several significant advantages over the currently existing system. The partial transfer of the quality and safety program to a digital format implies an increase in both the quality and accessibility of medical care. In the conditions of a tense financial situation, a large territory, limited resources and a changing demographic situation, new technological solutions are required, which is the digital transformation of existing processes (Kleinpell, 2021). Digitalization of risk factors assessment and prevention of a healthy lifestyle will give patients the opportunity to monitor their health, actively participate in the collection of medical data, and the choice of the attending physician or treatment strategy.

Potential Obstacles & Solutions for Overcoming

An increase in the number of errors associated with the use of telemedicine technologies in the provision of medical care is considered as the main potential obstacle. As a way to overcome it, the restriction of types of remote medical care can act. Secondly, many scientists note a sharp increase in the risks associated with the protection of information (ihi.org, 2017). These threats exist today, but they are on a smaller scale, localized within one medical organization. The way to overcome this obstacle is to teach information security in universities as a separate discipline and at a high level. This will allow implementing numerous organizational, software and hardware solutions to protect patient information from leakage.

Stakeholders

Stakeholders within the selected healthcare entity with whom I may need to collaborate are patients, chief physicians, advanced nurse practitioners and software developers. The role of patients is in testing applications developed for them to assess risk factors and early diagnosis of hypertension. They should also provide feedback on the work of applications aimed at forming a healthy lifestyle. The role of patients is to make complaints, wishes and suggestions regarding various aspects of digitalization of medical processes. Developing feedbacks will allow to find out what can be improved for a more comfortable use of the developed applications. Constructive and specific comments from customers will be useful for continuous improvement and further popularization of the virtual quality and safety program.

The role of software developers in the implementation of the proposed program is to develop an application that will act as an intermediary between doctors and patients. They will also need to ensure the safety of personal patients in order to prevent their leakage. Software developers are responsible for each of the six stages of application development (Carey et al., 2018). Among them are the design of an idea, strategy development, design work, direct development, market entry and monitoring of the situation. Programmers will carry out strategic planning in the form of drawing up a roadmap for a mobile application. Then they will carry out the path from the minimum viable product (MVP) to getting into the use of patients and doctors (Brantley & Chipps, 2021). At the same time, it is necessary to take into account the functionality of the application, the possible wishes of the audience and the following updates. Software developers will also be responsible for providing technical support and answering patients’ questions regarding the operation of the application.

Among stakeholders, it is also necessary to designate a specific group of advanced nurse practitioners. Since the digitalization of medicine in this case is connected precisely with the safety program regarding hypertension, they have a special responsibility. Telemedicine does not make it possible to completely abandon face-to-face interaction with nurses. However, with the help of technology, advanced nurse practitioners can perform an initial examination. At a remote reception, they can collect anamnesis, prescribe the necessary tests, and decipher them (Kleinpell, 2021). Then advanced nurse practitioners will also have to work with patient data and regular monitoring of medical indicators. Most often, users of remote medical care prefer to chat with a doctor. Therefore, advanced nurse practitioners are responsible for collecting patient indicators and providing them with full-fledged medical care.

Leaders that are needed are the chief physician doctors who will act as a link between patients, advanced nurse practitioners and developers and technical support. The chief physicians will manage the changes in accordance with the plan defining the activities of stakeholders. Moreover, it is the chief physician who will organize the work of a team of advanced nurse practitioners to provide timely and high-quality medical and medicinal care to the population. They will also ensure the organization of medical and preventive, administrative, economic and financial activities related to the operation of the application (Carey et al., 2018). The chief physicians will analyze the activities and, based on the assessment of the performance of the application and doctors, take the necessary measures to improve the existing forms and methods. They will also monitor compliance with the requirements of the internal labor regulations, safety and labor protection.

Change Management Theory

A change management theory I will use to support the implementation of my quality and safety program is the ADKAR management model. It was developed by Prosci Change CEO Jeff Hiatt; at the center of this concept are the employees who are affected by the changes (ihi.org, 2017). ADKAR is a set of five stages that each of the advanced nurse practitioners must pass sequentially. Among these stages are Awareness, Desire, Knowledge, Ability and Reinforcement (Bekemeier et al., 2021). To evaluate the results, the chief physician should use a scale from one to five (Beaussier et al., 2020). If an employee scores three points or less at one of the stages, they should improve their result, and only then can they move on to the next step.

Evidence of the effectiveness of using the ADKAR management model within the program I designed is the potential reduction of resistance to change among employees. Often, the introduction of new technologies is associated with difficulties for employees, and they perceive changes negatively (Bekemeier et al., 2021). Unwillingness to master new technologies, disguised as inability, is often practiced. The ADKAR management model focuses on developing doctors’ desire to support and participate in changes. With the use of this model, one can be sure that the changes will be successful, since staff will be motivated to contribute to innovations (Barone Gibbs et al., 2021). For this reason, advanced nurse practitioners will not resist the development of new technologies and will be able to master the work with the application.

Expected Outcomes

The expected outcomes of the implementation of my proposed quality and safety program are increasing the availability of cardiology medicine. In the future, this includes the use of remote-type medical equipment: this is equipment for receiving and sending data to doctors. With the help of specialized software for a smartphone or computer, anyone will be able to track risk factors, correct them, as well as send information about their condition and get advice remotely. These are just some of the possibilities of using machine-to-machine interaction technologies (Kleinpell, 2021). Among the outcomes of the introduction of telemedicine networks is the solution of the most important social tasks. First of all, it is the provision of high-quality cardiological services to healthcare institutions, regardless of their location (Arija et al., 2018). It also includes monitoring and counseling during and after complex surgical interventions, and general monitoring of risk factors and the state of cardiovascular health.

There are different ways to ensure sustainability of the expected outcomes. They include raising the level of the material and technical base and laboratory, functional and instrumental diagnostics. Moreover, for the interest of advanced nurse practitioners, it is necessary to raise their wages, which will act as a guarantee of a constant high quality of medical care to the population. Management courses for chief physicians should also be conducted regularly to ensure more effective communication between patients and doctors (ihi.org, 2017). To ensure sustainability of the expected outcomes, continuous education of advanced nurse practitioners should also be provided, developing both professional knowledge and skills of working with new technologies.

Conclusion

This paper contributes to the rationale for the development of telemedicine, emphasizing its use in the field of cardiology. The new quality and safety program for the prevention and treatment of diseases of the cardiovascular system transforms the existing concept of risk factors and a healthy lifestyle. It will be based on new remote forms of interaction between the attending physician and the consultant physician, the medical worker and the patient. Telemedicine will be cost-effective only if it becomes a queuing system at the state level. Modern innovative development of national healthcare is impossible without a comprehensive combination of traditional clinical methods and modern info communication technologies quality and safety program. The introduction of digitalization, aimed at improving the management system in healthcare, will significantly increase the number of positive outcomes.

References

Arija, V., Villalobos, F., Pedret, R., Vinuesa, A., Jovani, D., Pascual, G., & Basora, J. (2018). Physical activity, cardiovascular health, quality of life and blood pressure control in hypertensive subjects: Randomized clinical trial.Health and Quality of Life Outcomes, 16, 1-11. Web.

Barone Gibbs, B., Hivert, M. F., Jerome, G. J., Kraus, W. E., Rosenkranz, S. K., Schorr, E. N., Spartano, N. L., Lobelo, F., & American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology (2021). Physical activity as a critical component of first-line treatment for elevated blood pressure or cholesterol: Who, what, and how?: A scientific statement from the American Heart Association.Hypertension, 78(2), 26–37. Web.

Beaussier, A., Demeritt, D., Griffiths, A., & Rothstein, H. (2020). Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality. Health Policy, 124(5), 501-510.

Bekemeier, B., Kuehnert, P., Zahner, S. J., Johnson, K. H., Kaneshiro, J., & Swider, S. M. (2021). A critical gap: Advanced practice nurses focused on the public’s health. Nursing Outlook.

Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and control of hypertension: JACC Health Promotion Series. Journal of the American College of Cardiology, 72(11), 1278–1293.

Kleinpell, R. M. (2021). Outcome assessment in advanced practice nursing (5th ed.). Springer Publishing Company.

Nelson-Brantley, H. V., & Chipps, E. (2021). Implementation science and nursing leadership: Improving the adoption and sustainability of evidence-based practice. JONA: The Journal of Nursing Administration, 51(5), 237-239.

ihi.org. (2017). QI 202: Addressing small problems to build safer, more reliable systems. Web.

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