Strategies for Hypertension and Multiple Risk Factor Follow-Up Care

Curzio, Joan Lillian (1994) Strategies for Hypertension and Multiple Risk Factor Follow-Up Care. PhD thesis, University of Glasgow.

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Abstract

Even though hypertension had been long identified as a major cardiovascular risk factor affecting up to 20-25% of the Scottish adult population (Hawthorne et al 1974), follow-up care had continually been shown to be inadequate (Hawthorne et al 1974, Miall & Chinn 1974, Heller & Rose 1977a,b). By 1981, nurse practitioner care, which had been established in the United States, had been judged to be at least equivalent to physician follow-up care in the ambulatory care setting (Sox 1979). In addition, microcomputer systems were being developed to facilitate data collection, standardisation, retrieval and information analysis (Lilford & Chard 1981). Therefore, a project was initiated to evaluate the effectiveness of a nurse practitioner hypertension follow-up clinic with a microcomputer patient information system. Additional research projects were generated directly from the patient problems revealed with long-term follow-up, and carried out within this alternative care setting. Over 8 years, 1091 patients were admitted to the clinic with 705 (65%) continuing to attend at the end of Year 8 and only 11% of the population were lost due to non-attendance (Chapter 3). Blood pressure control was achieved in a substantial percentage of the population from the first year and was maintained throughout (Chapter 3), with slight improvements between Year 6 and Year 8 for those attending both years, concurrent with a change in emphasis of care from hypertension to multiple risk factor intervention (Chapter 7). There was greater blood pressure control in the nurse practitioner clinic patients compared with age/sex matched controls attending conventional hypertension clinics (Chapter 4). The identification of increasing lipids in a population attending continuously for 4 years, cind the high incidence of other risk factors, lead to the Cholesterol/Diet Study (Chapter 5) and the Guar Gum Study (Chapter 6). The effect of intensive lipid lowering dietary advice by dietitians over a 6 month period, in hyperlipidemic hypertensive patients, was shown to be limited with only a 2% greater reduction in mean cholesterol in the Advice Group compared to the No Advice Group. At the end of the study 56% of the Advice Group and 57% of the No Advice Group continued to have a total cholesterol >6.5 mmol/1 (Chapter 5). The soluble fibre guar gum was shown to have no effect on weight or blood pressure. A 6% reduction in total cholesterol in the lipid sub-group was nonsignificant in comparison with no change in the bran control. In addition, there was a high incidence of socially unacceptable side effects (Chapter 6). Levels of reported smoking decreased over time in the clinic and were less than the Scottish population averages. The average weight in the clinic did not change, but clinically modest, but statistically significant reductions, were observed in those with Body Mass Index > 30. There were no changes in reported levels of alcohol intake (Chapter 3 and Chapter 7). In conclusion, nurse practitioner care is as good as conventional hypertension care for the long term follow-up of hypertensive patients and may be more effective in terms of maintaining follow-up and adherence to management protocols. A microcomputer patient information system can facilitate the every day management of an outpatient clinic as well as providing data for research and audit. This system is capable of responding to and integrating the developments in knowledge and understanding which demand change in the provision of care. Finally, the success of current strategies for decreasing overall cardiovascular risk by decreasing levels of established risk factors, such as increased total cholesterol, smoking, excess weight and excessive alcohol consumption is limited.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Additional Information: Adviser: John Reid
Keywords: Medicine
Date of Award: 1994
Depositing User: Enlighten Team
Unique ID: glathesis:1994-75468
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 19 Nov 2019 20:01
Last Modified: 19 Nov 2019 20:01
URI: http://theses.gla.ac.uk/id/eprint/75468

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