Nursing Notes

November 13, 2009

Home monitoring and Hypertension?

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Study: Regularly watch pressure

Duke doctors say at-home monitoring, plus calls from nurse, lowered blood pressure.

By Sarah Avery
savery@newsobserver.com
Posted: Saturday, Nov. 07, 2009

More Information

  • High blood pressure is defined as a reading of 140/90.

  • It is a factor in:

    77 percent of first-time strokes

    69 percent of first-time heart attacks

    74 percent of Americans with congestive heart failure

     

    SOURCE: American Heart Association

As Congress weighs options for cutting some of the $2.2 trillion Americans spend on doctors, surgeries, treatments and drugs, some solutions may be as simple as a phone call.

A team of Duke University Medical Center doctors and nurses has found they can help lower patients’ blood pressure with a do-it-yourself monitoring plan and bi-monthly phone calls from a nurse.

The experimental intervention, which lasted two years, cost about $400 per patient – including the blood pressure monitors, bought in bulk at Costco. If the program keeps just one patient from having a heart attack or stroke, it pays for itself and then some, doctors say.

High blood pressure is a leading contributor to cardiovascular disease, a huge killer in North Carolina. Heart disease is the leading cause of death, and stroke is No. 3, behind cancer.

People can lower their blood pressure with drugs, and many also can reduce their pressure with lifestyle changes such as exercise and a healthy diet.

But such efforts take diligence, and that’s where the Duke project had its success, said Hayden B. Bosworth, a research professor and lead author of a study about the program published last month online in the Annals of Internal Medicine.

“I like to think what we can do is empower people to help themselves as much as possible to do what’s needed, and in an environment that’s best for them,” Bosworth said.

The program divided more than 600 patients into four groups. The first got the normal intervention of drugs and periodic doctor visits. A second group was given home blood-pressure monitoring devices and training to use them. A third was called at home by nurses to discuss healthy living options. The final group got both the home-monitoring devices and the nurse calls.

The last group had the greatest reduction in blood pressure, with an average 11 percent drop. The group who simply monitored their blood pressure saw a 7.6 percent reduction in blood pressure, and patients who got the phone calls alone recorded a 4.3 percent decline.

Bosworth said the program proves patients with high blood pressure benefit from frequent monitoring, not unlike diabetes patients taking blood-sugar readings.

For Christine Rodio, a patient in Durham, knowing when her blood pressure was elevated enabled her to take immediate action to exercise more, cut salt, eat healthy fruits and vegetables and try to reduce stress.

“I really began paying attention to the food I ate,” Rodio said, noting that her goal wasn’t to lose weight but to make sure she was making healthy selections.

She said the regular calls from nurses also helped keep her on track.

“It helped knowing that someone else was interested in controlling my blood pressure, and that I could do things to help,” Rodio said, adding that she felt compelled to hold up her part of the bargain because the nurse was so invested in her progress. “I didn’t want to let her down. She was working hard at this, too.”

The Duke team hopes the program will spread. It has developed a training package and information to offer public-health clinics, hospitals and doctor’s offices.

View the original article here

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Here is an example of thinking outside of the box.  I have always felt  there was a better way to follow-up and connect with patients than what is in place right now.  The problem is that to have the physician’s nurse calling and following up the patients, the nurse would have to actually be available to do so.

Right now when I call my physician’s office and ask to speak to his nurse, I end up in a voice mailbox and never get to actually speak with a person.  I may or may not get a call back in a timely manner.  This could be a problem.

 

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