Theses and Dissertations at Montana State University (MSU)
Permanent URI for this collectionhttps://scholarworks.montana.edu/handle/1/733
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Item Improving blood pressure screening and control in primary care: a quality initiative(Montana State University - Bozeman, College of Nursing, 2023) Gomendi, Wendy Michelle; Chairperson, Graduate Committee: Molly SecorBackground: Hypertension costs the United States healthcare system billions of dollars and accounts for 1 in 6 deaths annually. Management of hypertension is a priority in primary care settings. Strategies to prevent the adverse health effects of hypertension in the United States include increasing awareness of the health risks of uncontrolled hypertension, promoting the use of healthcare teams to manage hypertension, and empowering patients to use self-measured blood pressure monitoring. Local Problem: To address the high rate (58%) of uncontrolled hypertension at a family practice clinic in Montana, a QI project was implemented aimed at improving blood pressure screening, management, and control. Methods: The Knowledge to Action model guided the development of a workflow that incorporated an existing hypertension management policy based on USPSTF hypertension screening and management recommendations. Interventions: Interventions were implemented over four weeks. All patients presenting to the clinic with a blood pressure > or = 140/90 were rescreened at the end of the visit. If the blood pressure remained elevated, the clinic staff was asked to provide an informational packet and ask the patient to obtain home blood pressure measurements or return in 7-14 days for a blood pressure check. Individuals with three elevated blood pressures on three separate occasions were referred to their care team for further hypertensive management. Results: The project goals were not achieved; however, the percentage of hypertensive patients with a blood pressure > or = 140/90 decreased by 4%. Conclusion: The QI initiative resulted in a modest increase in hypertension control for the project site. Although goals were not met, the project provided insight into hypertension management barriers, including time constraints on the providers and staff, patient willingness to engage in serial blood pressure measurements, and readiness of providers and patients to escalate hypertensive medication therapy.Item Preeclampsia and increased risk of cardiovascular disease: a practice guide for providers(Montana State University - Bozeman, College of Nursing, 2020) Toole, Brielle Ashli; Chairperson, Graduate Committee: Sandra Benavides-VaelloCardiovascular disease (CVD) is the leading cause of death among women, however this disease is preventable and treatable. Extant evidence has established that women with a history of preeclampsia are at an increased risk for developing CVD later in life, and yet preeclampsia is under-recognized as a risk factor for CVD. This is due to a knowledge gap amongst healthcare providers, and subsequently providers are not adequately educating their patients with a history of preeclampsia about their CVD risk and reducing this risk. There are no specific guidelines regarding long-term care or screening for CVD in women with a history of preeclampsia, so a guideline needs to be developed to assist providers in caring for this high-risk population. The first aim of this project is to develop a guideline for providers to use in practice while caring for women with a history of preeclampsia, and the second aim is to enhance providers' knowledge of the link between a history of preeclampsia and increased CVD risk later in life so they can provide improved, evidence-based care. This project used a pre-survey, educational content with dissemination of two practice guidelines in different formats and a patient educational handout, and post-survey approach. The project targeted healthcare providers who care for women with a history of preeclampsia at a small rural hospital. Providers who participated in this project did have knowledge of the link between preeclampsia and increased CVD later in life, but were not applying this knowledge to their practice, as they neither took a thorough pregnancy history from their patients in regards to preeclampsia nor provided counseling to women with a history of preeclampsia about their increased risk of CVD. Providers who reviewed the guideline presented in this project found it helpful and had or planned to implement a practice change because of the guideline. The practice guideline developed was an effective tool to help the providers in this project implement evidence-based care into their practice, and the patient handout was an additional resource they could use to educate their patients with a history of preeclampsia.