Assessing the Problem Part 1

NURS FPX 4900 Assessment 2 Assessing the Problem: Quality Safety and Cost Considerations CG

Hypertension is a common condition that can lead to severe health complications in an individual. Based on the recent reports from the Centers of Disease Control and Prevention (CDC), nearly half of adults in the United States (47%, 116 million) have hypertension. Among the adults, 1 out of 4 adults (24%) with hypertension have their condition under control and 45% with uncontrolled hypertension (CDC, 2020). According to Sawase et al. (2019), hypertension prevalence is predicted to increase to 1.56 billion adults in 2025. Even though the prevalence of hypertension is likely to increase, the primary struggle existing among the affected is disease management. To ensure that disease management is made effective, data metrics need to be observed based on the quality, safety and cost of disease management process. For this assessment, the essay will address the effects of hypertension on quality of care, patient safety, and costs to the system and individual.  

Quality Care

According to The World Health organization reports, hypertension is one of the prevalent and leading causes of premature deaths across the world. Upoyo et al. (2021) provide that the leading factors for uncontrolled hypertension include undetected changes, patient unawareness and lack of stable treatment patterns. Therefore, evaluating risk factors in the patient requires examination of the patient’s knowledge base, willingness to medication adherence, treatment and management (lifestyle modification), and attitudes towards the management. In particular, a lack of patient modification in exercising self-care increases the risks of hypertension, making management difficult (Najimi et al., 2018). In some cases, patients choose not to adhere their antihypertensive medication regimen for fear of becoming dependent on the drugs. Other cases involve barriers to quality care that are associated with attitudes towards the requirement of lifestyle modification as a treatment strategy. Najimi et al. contend that patients experiencing hypertension require family support to ultimately enable them to thrive through lifestyle modification processes. 

Improving Quality Care

The treatment and management of hypertension is dependent on the ability of the patient to significantly modify their lifestyle and adhere to treatment plans. As mentioned above, barriers to lifestyle modification among hypertensive patients is reported to be lack of family support and their attitudes towards the process. For this reason, the healthcare providers are required to guide the patient and educate them on the importance of changing their lifestyle as a way of influencing their attitude. Also, it is imperative that the professionals ensure that while utilizing a patient-centered care model to facilitate treatment and management of hypertension, they should also engage the middle-range theory of nursing framework so that they can be guided on practices of quality care improvement (Drevenhorn, 2018). The middle-range theory is an evidence-based framework that comprises of nursing concepts related to care, patient-centeredness, and expected outcomes that guide nurses on their scopes of practice to inform on the strategies for improving care for patients with hypertension (Drevenhorn, 2018).

Patient Safety

Patient safety is a central concern in healthcare services, including hypertension management. Several barriers influence effectiveness in patient safety, including ineffective communication, low patient education levels, and lack of interdisciplinary collaboration. According to Tiwary et al. (2019), ineffective communication can potentially lead to medication errors, lack of adherence to medication plans, incomplete follow-ups and uninformed adjustments. On the other hand, considering that patients with hypertension require treatment for other comorbidities, interdisciplinary collaboration is essential to ensure care coordination. According to Rosen et al. (2018), collaboration saves on preventable medication errors and enhances quality care for patients. The provision of education to patients with hypertension is essential in guiding them through the requirement of lifestyle modifications, follow-up care strategies, self-management, change detection and treatment regimens. According to Wu & Busch (2019), lack of adequate education on patients threatens their well-being and safety. 

Enhancing Patient Safety

The effectiveness of enhancing patient safety can be related to patient outcomes. According to Wu and Busch (2019), optimization of patent safety requires engaging patients through effective communication as a component of facilitating adherence and compliance to a medical regimen. Patient-centered care is an imperative EBP approach recognized to increase patient safety and satisfaction in the healthcare system. Through patient-centered care, there are possibilities of reduced medication costs and enhanced quality of care, hence achieving patient safety. 

Cost Consideration

Based on research conducted by Kirkland et al. (2018) concerning the utilization of the Medical Expenditure Panel Survey (MEPS), the patients that were diagnosed with hypertension incurred extra medication costs of approximately $200 more each year compared to those free of the disease. On the other hand, the American Heart Association, patients with hypertension incur 3 times more costs on medication prescriptions and twice as many inpatient and outpatient costs compared to those without hypertension. Based on Kirkland et al. (2018) statistics, the United States patients with hypertension incurred $131 billion in healthcare costs higher than those without. Therefore, hypertension potentially increases the healthcare costs for its patients.

NURS FPX 4900 Assessment 2 Assessing the Problem: Quality Safety and Cost Considerations CG

Reducing Cost

There are considerable evidence-based practices and strategies that patients with hypertension can employ in reducing costs incurred of their medication. For instance, according to American Heart Association (AHA), the reduction of healthcare costs for patients with hypertension starts with considerations of healthcare providers in improving detection, prevention of triggers and proper management of the disease. On the other hand, Vise (2019) suggests that early intervention after diagnosis of hypertension is an effective method to slow the damage, lower risks of comorbidities and consequently lower medication costs. Another strategy involves maintaining blood pressure levels through regular check-ins and close monitoring (Vise, 2019). Interdisciplinary collaboration is another way of reducing medication costs since medication errors will be reduced for patients with hypertension and additional charges for double medication. 

The Effects of Policy

Healthcare policies have the potential to influence the impact of hypertension on the quality of care, patient safety, and costs incurred for medication. For instance, the Affordable Care Act (ACA), initiated by President Barack Obama in 2010, concerns increasing patients’ access to healthcare services and serves to decrease healthcare costs. According to Mclntyre &Song (2019), the ACA potentially expanded Medicaid funding, creating more opportunities for the vulnerable population to access healthcare services. For this case, ACA actively affects the treatment and management processes for patients with hypertension since it expands their access to quality healthcare services through insurance (Mclntyre &Song, 2019)

With the gains in insurance coverage, patients who had not acquired insurance due to denials for preexisting conditions, the ACA meant that all people had access to healthcare, which translates to improved diagnosis of hypertension, possibilities of detecting and tracking changes, easy access to medications, and better adherence to treatment plans. In other words, the insurance coverage by ACA is an effective strategy for reducing medications costs that may potentially influence the effectiveness of hypertension management and treatment. Cleverland et al. (2019) describe the effects of ACA legislation on the nursing scope of practice by contextualizing its effects on quality care, patient safety and medication costs. According to him, ACA provides an initial legislative framework that links the concepts of quality care, value in health spending and patient safety to payment initiatives. Cleveland et al. provide that ACA established Hospitals readmission reduction program (HRRP) to track the practice of nurses on the medication costs, including readmissions. Through this idea, the nurses are likely to adhere to medication ad treatment plans that facilitate the reduction of medication costs. Under the promotion of state control of insurance, the nursing scope of practice on quality and patient safety is made effective through regulations requiring improved health outcomes, reduced medical errors, and readmission prevention.

Assessing the Problem Part 2

NURS FPX 4900 Assessment 2 Assessing the Problem: Quality Safety and Cost Considerations CG

As previously discussed, Mr. Doe, is a 63-year-old Caucasian male who was diagnosed with hypertension two years ago. During my meeting and discussion with him, based on the problems that he is experiencing, I realized that he struggled with knowledge about the disease, the information provided previously by the healthcare provider concerning lifestyle modification led to increased stress, he experienced financial strain due to his inability to work and his access to resources is limited considering that he stays in rural areas. With the knowledge from the research I conducted on disease management, including reviews from peer-reviewed articles and EBP documents, I learned that the middle-range theory was an appropriate approach to be implemented in Mr. Doe’s disease management process. Having approached Mr. Doe with the idea, I first assessed his willingness to engage in the process and readiness to initiate life modifications, including stopping smoking and ensuring low sodium intake. Based on the response from Mr. Doe that he wishes to live long to see his grandchildren prosper, it was clear that he was willing to adopt a lifestyle modification plan for the disease management process. While sharing with Mr. Doe about his experience after the diagnosis and the treatment process, he demonstrated positivity to the next management plan and promised to comply. When I presented the problem to Mr. Doe, I realized several barriers he encountered that prevented him from properly managing the disease. Some of the barriers include ineffective communication from his healthcare provider, inadequate knowledge about the disease and self-management procedures, limited resources, financial constraints and lack of effective care coordination and collaboration. 

In the process of discussing with the patient the strategies to use to improve his outcome, he asked for more guidelines so that he could meet his goal. As a leader, I communicated the possible strategies through which I realized that the patient-centered care approach was the most effective considering Mr. Does’ situation. According to him, collaboration and teamwork were the most beneficial strategies towards realizing positive outcomes since he needed motivation and reminders to ensure an effective response to lifestyle adjustment. During the interactions, I communicated to Mr. Doe about middle-range theory while I made relevant references; I used guidance leadership skills to mentor, motivate and cultivate the environment for Mr. Doe to effectively comply with the medication regimen and lifestyle change practices. I created a sense of urgency based on the information I acquired from his policy requirements as a way of overcoming the barriers that the patient experienced. With the data, he understood in details disease management strategies and what was expected of him. 

Conclusion

In summary, the assessment of hypertension under costs, quality and safety considerations requires a coordinated approach to ensure improved patient outcomes are achieved. Hypertension impacts the quality of care, patient safety and medication costs in many ways. However, as a healthcare provider, it is imperative to utilize a patient-centered care framework to ensure patient safety, interdisciplinary collaboration to ensure care coordination and reduction of medication costs and expansion of the nursing scope of practices to ensure the provision of quality care. Patient-centered care model provides an effective strategy to meet patient needs when dealing patients with hypertension, which includes quality care, patient safety and medication cost reduction. 

References

CDC (2020). Facts About Hypertension in the United States https://www.cdc.gov/bloodpressure/facts.htm 

Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: harnessing the power of nurses. Online Journal of Issues in Nursing, 24(2).

Drevenhorn, E. (2018). A proposed middle-range theory of nursing in hypertension care. International journal of hypertension, 2018.

NURS FPX 4900 Assessment 2 Assessing the Problem: Quality Safety and Cost Considerations CG

Kirkland, E. B., Heincelman, M., Bishu, K. G., Schumann, S. O., Schreiner, A., Axon, R. N., … & Moran, W. P. (2018). Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003–2014. Journal of the American Heart Association, 7(11), e008731.

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS medicine, 16(2), e1002752.

Najimi, A., Mostafavi, F., Sharifirad, G., & Golshiri, P. (2018). Barriers to medication adherence in patients with hypertension: A qualitative study. Journal of Education and Health Promotion, 7.

Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433.

Sawase, G. B., Kumthekar, S. G., Salphale, S. N., & Doibale, M. K. (2019). A study of the prevalence of hypertension and socio-demographic factors in urban slum, Maharashtra.

Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome open research, 4.

Upoyo, A. S., Setyopranoto, I., & Pangastuti, H. S. (2021). The modifiable risk factors of uncontrolled hypertension in stroke: A systematic review and meta-analysis. Stroke Research and Treatment, 2021.

Vise, S. (2019, August 02). Four Principles to Help Control the High Cost of High Blood

Pressure. Retrieved January 16, 2021, from https://healthmetrics.heart.org/fourprinciples-to-help-control-the-high-cost-of-high-blood-pressure/ 

Wu, A. W., & Busch, I. M. (2019). Patient safety: A new basic science for professional education. GMS Journal for Medical Education, 36(2).

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