Hypertension & Proactive Nurse Case Management Research Essay

Hypertension & Proactive Nurse Case Management Research Essay

In the context of nursing, an important role belongs to nursing case management. Case management can be defined as the process of coordinating and organizing services and resources to match healthcare needs in the illness and care environment (Finkelman, 2010). The responsibilities of case manager nurses include coordinating long-term care programs for their patients, assessing patient needs and ensuring that patients receive optimal care.Hypertension & Proactive Nurse Case Management Research Essay


One important direction of case management is proactive case management which relates to developing a systematic case management plan and healthcare interventions aimed at populations with specific healthcare conditions (Finkelman, 2010). Due to proactive case management, patients’ self-care health choices become more efficient and contribute to improving the quality of life of the target population (Mullahy, 2010). The purpose of this paper is to consider hypertension issue in the general population and proactive nurse case management addressing this issue.Hypertension & Proactive Nurse Case Management Research Essay

Hypertension is a chronic health condition characterized by elevated arterial blood pressure. Maximum normal blood pressure is assumed to be 140 mmHg systolic pressure and 90 mmHg diastolic pressure, so hypertension refers to arterial pressure above 140/90 mmHg (Black & Elliott, 2013).It is possible to distinguish between primary hypertension which constitutes between 90% and 95% of all hypertension occasions and secondary hypertension (Black & Elliott, 2013). The causes of primary hypertension are ageing, genetics, and various environmental factors. Secondary hypertension is the consequence of specific chronic diseases such as renal disease and endocrine conditions. Such factors as obesity, illegal drugs, sleep apnea, and aortal coarctation also cause hypertension (Black & Elliott, 2013).

Almost 78 million Americans have hypertension which means that almost one of three Americans experiences high blood pressure (AHA, 2013). About 18.5% of these 78 million live with chronic hypertension without being aware of this and 47.5% do not have their chronic hypertension controlled (AHA, 2013). It is expected that hypertension prevalence among Americans will increase by 7.3% by 2030 (AHA, 2013).Hypertension & Proactive Nurse Case Management Research Essay

Hypertension creates a number of health risks, starting with increased strain on the heart which leads to the development of coronary artery disease and hypertensive heart disease (Black & Elliott, 2013) and ending with increased chronic kidney disease risks, aortic aneurysm, stroke, peripheral arterial disease, etc (AHA, 2013). Hypertension also is known as a life-shortening factor in the case of at least moderately high blood pressure (Black & Elliott, 2013).

Hypertension commonly appears along with excess weight. Obese adults with BMI 30 and more have higher hypertension prevalence rates: according to AHA (2013), hypertension rates among men constitute 38.4% for men, while hypertension rates for women are 32.2%. In addition, hypertension often accompanies diabetes, alcoholism, inactivity, and stress (Black & Elliott, 2013). Hypertension increases the chances of death; the number of deaths from hypertension and related kidney disease is 8.9 per 100,000 population (AHA, 2013).

Hypertension decreases the quality of patients’ lives, increases health risks, worsens chronic diseases, and incurs additional healthcare costs. Hypertension has multiple causes; moreover, there are many people unaware of their hypertension condition. At the same time, it is possible to reduce the chances of a chronic hypertension condition in patients by preventing age-related blood pressure increase, lowering blood pressure level among the population, and targeting other hypertension risk factors. In particular, lifestyle factors such as sedentary way of living, alcohol intake, and increased salt consumption increase hypertension risks.Hypertension & Proactive Nurse Case Management Research Essay

It should be noted that persons with predisposition to primary or secondary hypertension have to be treated differently to prevent the development of hypertension. In addition, those who have genetic risks of obesity, diabetes, or hypertension need separate preventive measures. Therefore, in order to address healthcare risks associated with hypertension, to optimize healthcare costs, and to improve the target population’s quality of life, it is necessary to integrate healthcare services around the needs of individuals at risk. Such integration can be achieved with the help of a case management program for managing hypertension.Hypertension & Proactive Nurse Case Management Research Essay

Case management deals with multiple healthcare aspects and integrates them into a focused strategy. There are numerous potential benefits associated with a systematic hypertension case management plan. Case management contributes to the improvement of care quality due to careful choice of healthcare options and attentiveness to patients’ needs (Mullahy, 2010). With regard to hypertension, case management might also increase self-management skills of patients and their medical adherence. Research shows that the use of case management does not incur significant additional costs, but helps to improve health outcomes for the target patient groups (Finkelman, 2010).

The focus of case management is on specific populations and on achieving best health outcomes for these populations (Finkelman, 2010). Therefore, a person performing the coordination of case management activities should be familiar with health conditions, risk factors, key health issues, and needs of the target population. In addition, the coordinator needs to act as an advocate for patients, schedule medical testing and other healthcare activities, and act as a social worker in order to identify key patients’ needs and resolve them.Hypertension & Proactive Nurse Case Management Research Essay

The functions performed by nurses in fact include all elements of case management coordination, starting with planning and assessing care, ending with contacting the patients and identifying their needs. Nurses essentially place the quality of care and patient satisfaction in the first place. It is possible to state that care coordination has been a function of nurses’ activities since the turn of the previous century (Mullahy, 2010). Therefore, it is optimal to assign the responsibility for coordinating case management to experienced nurses.

Team-based care will contribute to enhancing the effectiveness of hypertension case management due to combining knowledge and experience of different healthcare professionals. With regard to hypertension case management, it is optimal to include a primary care physician, a pharmacist, a nutritionist, a community health worker, and a hypertension specialist. A nurse with proper hypertension expertise will coordinate team efforts, perform case management, provide counseling and education to the patient. The role of a primary care physician will be to conduct diagnostic and perform the evaluation of hypertension status. The pharmacist’s role will be to counsel team members and patients on the necessary medications, and the role of the nutritionist will be to provide counseling regarding dietary habits and lifestyle.Hypertension & Proactive Nurse Case Management Research Essay

The responsibilities of community health workers will include managing communications and assisting the patients in self-monitoring activities. The responsibility of a hypertension specialist will be to assess the patient’s condition and to determine special cases that might not respond well to commonly used therapies (Mullahy, 2010). Such team composition will help to develop an integral case management program and achieve optimal health outcomes for the target population.

The analysis of hypertension prevalence rates and consequences indicates that this disease is quite common among Americans. Hypertension incurs significant economic, healthcare, and social costs. Many people are unaware of their condition or predisposition, and ignore the factors contributing to the development of hypertension. Furthermore, hypertension is associated with more severe health risks and increases the chances of death. Hence, there is a need for a systemic case management program aimed at reducing hypertension risks, addressing hypertension-related factors, and improving the target population’s quality of life.Hypertension & Proactive Nurse Case Management Research Essay

The development of a systematic hypertension case management plan will help to improve health outcomes for the target group. It is recommended to assign the responsibility for case management coordination to experienced nurses because nursing functions include all key activities needed for coordinating case management. It is also recommended to form multidisciplinary teams for hypertension case management; such teams might include primary case physicians, pharmacists, nutritionists, community health workers and hypertension specialists. The combination of team-base care and hypertension case management strategy coordinated by experienced nurses will help to improve health outcomes for patients experiencing hypertension.

Patients who possess difficult health necessities represent a lopsided portion of social insurance spending or might be in danger of bringing about high spending sooner rather than later. These people ordinarily experience the ill effects of different interminable wellbeing conditions or potentially utilitarian confinements. Also, their human services needs might be worsened by neglected public necessities. They are regularly inadequately aided by present medicinal services conveyance and funding courses of action that neglect to sufficiently arrange care crosswise over various specialist co-ops and care settings.
As indicated by the American Case Management Association, the case-the board is “shared procedures that include correspondence and encourages care along a continuum through powerful asset coordination (CAMBRIDGE, 2014). Hypertension & Proactive Nurse Case Management Research Essay Objectives of the case the executives incorporate the accomplishment of ideal wellbeing, access to the mind and fitting usage of assets, offset with the patient’s entitlement to self-assurance”. In spite of the heap of adjustments that have been connected inside and outside of the United States of America (USA) framework, the conventional guideline of the case-the board continues as before: to guarantee coordination of a patient’s consideration through the task of a caseworker. The job of a caseworker can be assigned to affirmed caseworkers with or without a medicinal foundation just as to cutting edge essential consideration nurture or united wellbeing experts. Vital parts of case-the executives include: (I) characterizing and choosing objective people for which case the executives is most proper, for example, patients with multi-morbidities, patients every now and again admitted to medical clinics or patients requiring coordination inside and crosswise over wellbeing and social consideration; (ii) appraisal and individual consideration arranging; (iii) customary observing of patients; and (iv) change of consideration plans if essential. The essential errands of a caseworker are in this way to evaluate the patient’s and care’s needs, build up a custom-made consideration plan, sort out and change care forms appropriately, screen nature of consideration and keep up contact with the patient and overseer. Hypertension & Proactive Nurse Case Management Research Essay
Proof demonstrates that case-the executives diminishes the number of emergency clinics (re)admissions and improves tolerant fulfillment, while proof on cost-viability case-the executives stays questionable (Rouse, 2014). In such manner, a significant thought in structuring and conveying case-the board is that it ought to be conveyed to deliberately chosen gatherings of patients that are well on the way to profit by it. Giving people quality, financially savvy, and opportune consideration benefits regularly require synchronizing the right administrations according to the patient and conveying these administrations so as to guarantee that the consideration has ideal effects as proposed. Notwithstanding, it is basic to specify that as much as the adequacy of clinical administration has been demonstrated, the joining of clinical administration at the center of clinical consideration conveyance has been influenced by various variables with the most significant one being an absence of adequate installment. This content investigates the standards of the clinical case the executives and talks about a particular clinical case the board model for grown-ups with a formative incapacity in a medicinal home.
Attributes of progressively fruitful consideration the board programs
Interdisciplinary essential consideration models have exhibited a scope of positive results and are specifically noteworthy on the grounds that they may have expansive potential application in current practices. Research has recognized different component related to increasingly viable and effective essential consideration for more established grown-ups with perpetual sicknesses. They are: complete appraisal of the patient’s wellbeing conditions, medicines, practices, dangers, underpins, assets, qualities, and inclinations; proof based consideration arranging and checking to encounter the patient’s wellbeing linked essentials and inclinations; advancement of patients’ and domestic guardians’ dynamic commitment in consideration; and organization and correspondence among every one of the experts occupied with a patient’s consideration, particularly in advances from the emergency clinic (Wong, 2016). Fundamentally, a few qualities of increasingly effective consideration the executives projects incorporate choosing patients with intricate essentials however not those with disease so serious that comforting or hospital care would be extra suitable than consideration the executives; utilizing uniquely prepared consideration directors on multidisciplinary groups that incorporate doctors; stressing individual to-individual experiences, counting family holidays; training patients and people to participate in self-care and perceive issues right on time to keep away from crisis appointments and hospitalizations; and depending on casual parental figures in the home to help patients. Hypertension & Proactive Nurse Case Management Research Essay
Research examination of program plan in Medicare shows that the idea of communications among consideration directors and patients and doctors was the most grounded indicator of achievement in lessening emergency clinic use. These connections happened in an assortment of ways, for example, by gathering patients in the clinic or once in a while going with patients on encounters with their doctor. At the point when care-oversaw patients of these observes stayed the crisis offices or were admitted to the emergency clinics, care groups got ongoing notices, which enabled them to mediate in an opportune manner. Albeit transitional consideration is accepting consideration for its job in decreasing emergency clinic readmissions, it is just one of a few mediations expected to improve results for high-need, mind-boggling expense patients. Fruitful transitional consideration comprises of a few interrelated components which may be viewed as collected as one element in a more extensive consideration model.

Implementing Care Models Effectively
A few mediations with apparently comparable highlights accomplish different outcomes. Their relative achievement or disappointment might be ascribed to how mediation is executed, including social and specialized viewpoints. Associations that create care the executive’s projects are not really trying to plan comprehensively material models but rather a methodology that works in a particular location (Fraser, 2018). For instance, assessors establish the accomplishment of mind-boggling expense care the board at General Hospital originated from an official responsibility to building up a program custom fitted and completely incorporated into the framework of its human service.
To this point, an ongoing assessment of a few essential consideration coordinated complex consideration the board projects recognized normal administrative and operational methodologies: redoing the way to deal with the nearby setting and caseload; utilizing a blend of subjective and measurable strategies to distinguish patients; concentrating on structure confiding involved with patients and their essential consideration suppliers; coordinating group organization and intercessions to patient needs; offering particular preparing for colleagues; utilizing innovation to support care the executives endeavors. Best practices may be redone to suit various populaces’ needs and changes in innovation. For instance, a consideration supervisor’s job of filling in as a “correspondences center point” may develop as computerized wellbeing advances encourage better approaches for connecting with patients and assembling a virtual consideration group. In like manner, electronic instructing help may aid show self-care to patients with little wellbeing proficiency, while additionally diminishing consideration chiefs’ remaining burdens (Doebbeling, 2015).Hypertension & Proactive Nurse Case Management Research Essay
Continuity of Care


Continuity of care produces shifting positive results among various wellbeing disciplines. For example, among safeguard medication and general wellbeing professionals, congruity of consideration brings about improved arrangement finish, hypertension results, the ID of bacterial meningitis, and remedy consistence. One prime case of positive results inside wellbeing changing controls can be noted with maternity birthing assistant specialists. Fewer customers are growing hypertension during pregnancy, a genuine condition called preeclampsia, and fewer maternity patients want to demand painkillers during work. Purchasers experience expanded trust, affinity, and certainty with social wellbeing masters, and among asthma authorities, patients feel upgraded passionate and emotional wellness. Studies have demonstrated that congruity of consideration prompts upgraded nature of consideration and improves results crosswise over numerous controls. To keep creating positive patient results, tomorrow’s human services experts must endeavor in conveying congruity of consideration to advance network prosperity (Muscedere, 2018). The coherence of consideration is encouraged by a doctor drove, group-based way to deal with human services. It decreases the fracture of consideration and therefore improves tolerant wellbeing and nature of consideration. In this manner, the American Academy of Family Physicians bolsters the job of family doctors in giving a progression of consideration to their patients in all settings, both legitimately and by coordination of consideration with other social insurance experts. Hypertension & Proactive Nurse Case Management Research Essay
Beating Barriers to Sustainability and Spread of case management models
Research has distinguished five sorts of obstructions or difficulties in supporting and scattering new consideration models, which benefit to clarify why not many of these models have been broadly received by and by. Essentially distinguishing hindrances and empowering elements do not create change. To propel the field, experts can utilize proof-based execution and dispersal systems, which have indicated guarantee in controlling the versatile plan and spread of projects. Bundling instruments, preparing, and specialized help together with steady budgetary impetuses may improve the probability that neighborhood champions can build up the ability to take up compelling projects and practices. Budgetary motivating forces; absence of motivators to give care coordination and strong administrations under charge for-administration installment trouble of winning against expense for-administration impetuses to give adequate cost investment funds in a worthy time allotment. Ability to change; underlines essential consideration restricted ability to execute care the board models regardless of the rationale of doing as such in this model. Culture and workforce; proficient vulnerability and absence of learning and aptitudes required to take on new jobs receive a patient-focused worldview and change the way of life (Green, 2018). Framework: insufficient electronic wellbeing records frameworks and interoperability to help incorporated consideration the board and coordination over the consideration continuum. Proof: trouble scaling up a restricted proof from single-site or single-concentrates to various settings or endless conditions.
Components of Clinical Case Management Hypertension & Proactive Nurse Case Management Research Essay

most discussions and researches involving clinical case management involve five main components which are planning, assessment, monitoring, linking, and advocacy. The text below explores the mechanisms of clinical case management as outlined above. The clinical case management of patients with long-term health issues entails an evaluation and consideration of their wishes, available environmental resources, and their living skills. Additionally, the assessment should also encompass appreciation of their clinical status, motivations, social networks, and latent capacities of the patient. In this case, or the case manager to develop a clear understanding of the details mentioned above requires regular individual contact and observation of the patient, in addition to an exhaustive analysis of previous functioning and treatment. Adequate assessment ensures heroic management interventions or all long-term care patients.
Using the Evidence to Design Operative Programs for Specific Subpopulations
Care models are regularly intended to address the issues of specific populace portions under various installment courses of action and hierarchical settings (Rouse, 2014). For instance, slight old patients with practical confinements, who want long haul administrations and supports may profit by a consideration model which offer a complete arrangement of administrations to help autonomous existing by combining financing from the Medicare and Medicaid programs. Then again, Medicare recipients with genuine ceaseless diseases who needn’t bother with such long haul administrations and supports may profit by a consideration model, which expands on existing supplier connections and expense for-administration installment. Surveying and checking high-chance patients can decide when their wants alter and need an elective consideration model. Hypertension & Proactive Nurse Case Management Research Essay
However, changes between projects must be made consistently or will hazard intruding on the congruity of consideration. Some oversaw consideration associations, for example, the Visiting Nurse Service of New York, has built up an arrangement of projects dependent on basic consideration the executives’ standards customized to serve various fragments of the populace; this methodology offers the chance to acknowledge economies yet in addition requires a profundity of mastery (Venkatesh, 2016). Our amalgamation is constrained by an overall scarcity of top-notch proof on some consideration models, for example, those that incorporate long haul administrations and social backings into an essential consideration. A great part of the proof checked on originates from preliminaries in single locales or projects that target patients with explicit conditions, which brings up issues about the more extensive application. The discoveries of this short should be expanded by new proof from different methodologies that are at present being tried.
The Utah HOME program
The University of Utah Healthy Outcomes, Medical Excellence (HOME) Program was developed in 2000 as a solution meant to cater for a population that comprised of individuals with both chronic and disproportionately huge number of care needs in addition to poor accessibility of quality care. The population covered by the program includes children suffering from neurodevelopmental problems in addition to co-morbid behavioral health diagnoses. Currently, the HOME program offers crucial healthcare services to at least 1,200 children and grown-ups with various forms of neurodevelopmental problems. Most of the patients covered by the program suffer from various medical and mental conditions that co-occur (LaBarge, 2016). Therefore, the referenced population has similar traits to other populations that have benefited from clinical case management. Consequently, the HOME program works acts as its own Health Maintenance Organization. It is funded by the Utah Medicaid via per-member/month capitated model. In effect, the HOME program model has been extremely effective due to its flexibility in the provision of clinical case management.
Influence on Clinical Case Management Practice
As mentioned above, the Utah HOME program is a complex model that is made up of interdisciplinary personnel such as psychiatrists (with multiple qualifications in child psychiatry and pediatrics), family physicians, case managers, pediatricians, psychologists, registered nurses, certified behavior analysts and a registered dietician. The various inter-disciplinary staff members involved in the program make it possible for the program to serve the complex and needs of the clinical population.Hypertension & Proactive Nurse Case Management Research Essay
Among the professionals mentioned above are case managers who play an important and central role in the coordination of the multi-disciplinary personnel. Some of the responsibilities of the care managers include assessment o needs, coordination of care, clinical population monitoring, and advocacy of required services. In general they perform the functions that make up the components of clinical case management as explained earlier in the text and such roles and functions are in line with the set standards of practice (Venkatesh, 2016). The case managers in the HOME program have sufficient professional qualifications as they have attained adequate training in social work in addition to having undergraduate level of training in relevant fields such as nursing and psychology. Hence, the fact that all the case managers in the program have Bachelor’s degrees means that the team is well-staffed with qualified personnel capable of handling the population.Hypertension & Proactive Nurse Case Management Research Essay
Case Management in Patient-centered medical home
Patient-centered medical home(s) (PCMH) have been formed and progressive in the USA as a model for altering the association and transmission of vital consideration. Interest for PCMH rose because of persons’ absence of access to crucial consideration, challenges in exploring divided consideration frameworks and increasing expenses of consideration. It was progressive by probably the major critical consideration doctor public guidelines in the nation and its values were reinforced and broadly tried by a scope of consumers, specialists, and consumer associations. Hypertension & Proactive Nurse Case Management Research Essay
In wide terms, PCMH is a doctor corresponding group practice that can give care which is open, consistent, exhaustive and collected and carried with regards to family and network. The PCMH model receives an all-encompassing way to deal with managing patients with perpetual illnesses, co-and multi-morbidities by contribution an optional individual model of critical consideration where patients are doled out to specific medicinal homes and doctors. In this way, PCMH ought not to be viewed as a setting where care is conveyed but instead as a far-reaching model of association that sends the center elements of essential consideration. The key traits of PCMH are exhaustiveness, quiet centeredness, management, openness, quality, and security. Hypertension & Proactive Nurse Case Management Research Essay
Clinical targeted case management (CM) has been proved to be a crucial development in improving the healthcare sector through improving patient care, minimizing healthcare costs, and improving the experiences of patients (Rahtz, 2015). Providing individuals with quality, cost-effective, and timely care services often require synchronizing the correct services as per the patient and delivering these services in time to ensure that the care has optimum impacts as intended. Most discussions and researches involving clinical case management involve five main components which are planning, assessment, monitoring, linking, and advocacy. Thus, it is from these components that case managers derive their functions and roles. An example of a suitable model is the Utah HOME program which is referenced in the text. The program is a complex model that is made up of interdisciplinary personnel such as psychiatrists (with multiple qualifications in child psychiatry and pediatrics), family physicians, case managers, pediatricians, psychologists, registered nurses, certified behavior analysts and a registered dietician. The various inter-disciplinary staff members involved in the program make it possible for the program to serve the complex and needs of the clinical population. Hypertension & Proactive Nurse Case Management Research Essay

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