Assessing the Problem: Quality Safety and Cost Considerations
Hypertension is a threat to people’s quality of life, safety, and well-being. The Centers for Disease Control and Prevention [CDC] (2021) explains hypertension as blood pressure that is higher than systolic and diastolic blood pressure thresholds. In this sense, guidelines for diagnosing high blood pressure recommend 120/80 mm Hg as the normal systolic and diastolic blood pressure, enabling healthcare professionals to identify at-risk populations and diagnose hypertension based on figures above this cut-off value.
As a chronic condition, high blood pressure is the primary risk factor for various cardiovascular diseases, including heart disease, ischemic stroke, and peripheral arterial disease (Carey et al., 2018). Globally, about 1.28 billion adults aged 30-79 years have hypertension, yet approximately 46% of the affected people are unaware of the condition or effective treatment options (World Health Organization, 2021).
People’s unawareness of hypertension exacerbates more advanced and life-threatening conditions, such as heart disease and stroke. Based on the association between high blood pressure and more burdensome chronic conditions, it is valid to argue that elevated blood pressure affects the quality of care, patient safety, and healthcare costs.
Impacts of Hypertension on the Quality of Care
Quality of care is a multifaceted concept that underpins healthcare professionals’ roles and standards of practice. The World Health Organization (2020) defines the quality of care as “the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with evidence-based professional knowledge.”
In this sense, the desired outcomes of nursing practice and healthcare services include restoring people’s health, promoting recovery, alleviating suffering and pain, and safeguarding patient safety. When defining the quality-of-care phenomenon, it is vital to consider its multiple dimensions proposed by the Institute of Medicine (IOM). These dimensions are safety, people/patient-centeredness, timeliness, equity, efficiency, and effectiveness (World Health Organization, 2020).
For example, healthcare professionals should provide care that respects and responds to individual preferences, values, and needs, while avoiding harm, addressing the underlying disparities, and incorporating the best evidence to support practices and inform clinical decisions.
Although providing quality care is an overarching goal of healthcare organizations and professionals, it is a daunting endeavor due to the prevailing internal and external environments. For instance, a high prevalence of chronic diseases is one of the significant challenges facing healthcare systems amidst the need to provide quality service. Hypertension is equally burdensome to healthcare professionals and facilities since its prevalence and effects affect the overall quality of care.
High blood pressure increases the individual propensity to more burdensome chronic conditions, including stroke and heart disease. Oparil et al. (2018) argue that hypertension is a preventable risk factor for cardiovascular diseases (CVDs) and the leading contributor to all-cause death and disability-adjusted life years (DALYs).
The association between high blood pressure and other chronic diseases prompts healthcare professionals to understand the individual’s genetic, social, economic, environmental, and cultural issues that contribute to people’s propensity to high blood pressure.
As a result, unmet needs for at-risk populations and people with hypertension affect the quality of care by requiring care providers to focus on primary, secondary, and tertiary prevention approaches. Finally, people with high blood pressure require individualized care interventions and regular follow-ups to enhance the effectiveness and impacts of pharmacological and non-pharmacologic strategies. These demands affect the perspectives of quality care.
Impacts of Hypertension on Patient Safety
Patient safety is a crucial dimension of quality care since it entails preventing, averting, and confronting issues or events that can jeopardize or threaten a patient’s health and wellness. According to Varkey (2021), healthcare professionals are responsible for preventing harm and benefiting the patient.
On the other hand, Lawati et al. (2018) adopt the World Health Organization’s definition of patient safety as the determination to avert harm and the prevention of adverse events, including medication errors. A high prevalence of hypertension and associated morbidities compromise of patient safety by contributing to premature deaths, disability-adjusted life years, poor quality of life, and prolonged hospitalization. Once healthcare professionals diagnose patients with hypertension, they focus on secondary and tertiary prevention strategies, including medications and modifying risk factors to prevent the condition’s progression.
Impacts of Hypertension on Cost to the System and the Individual
Hypertension inflicts massive economic burdens on healthcare systems and Individuals, including upsurged costs of improving symptoms and alleviating complications associated with elevated blood pressure. The Centers for Disease Control and Prevention (2022) presents hypertension as a costly public health problem that costs the US healthcare system approximately $131 to $198 billion annually.
The economic burden of hypertension includes the loss of productivity due to premature death, the costs of healthcare services, and medications for treating elevated blood pressure (Centers for Disease Control and Prevention, 2021). Equally, individuals with hypertension bear the cost burden of the condition, especially if they are underinsured or uninsured. In this sense, they face increased out-of-pocket expenses for paying for frequent consultations, medications, and other healthcare services.
How State Board of Nursing Practice Standards and Organizational or Governmental Policies Affect Hypertension’s Impact on the Quality of Care, Patient Safety, and Costs to the System and individual
Primary, secondary, and tertiary prevention strategies for hypertension are consistent and dependent on practice standards, organizational policies, and governmental policies. Firstly, practice standards guide healthcare professionals by establishing professional and ethical responsibilities.
For example, the American Nurses Association (ANA) Code of Ethics contains nine provisions that focus on various thematic areas, including demonstrating compassion and respect for inherent dignity, commitment to work with patients, families, and communities, the advocacy role of nurses, improving environmental conditions to support quality healthcare, incorporating research and scholarly inquiry into clinical practices, and the need to collaborate with other professionals and integrate the principles of social justice (Haddad & Geiger, 2022). These practice standards can guide my actions for improving patient safety, care quality, and reducing care costs.
Secondly, our organization has a functional policy of early hypertension screening and community health promotion through educational programs. According to Schmidt et al. (2020), early hypertension detection enables healthcare professionals to identify high-risk groups, promoting timely treatment and management of risk factors for high blood.
Also, timely screening can contain health-related costs associated with hospitalization and reduces the risk of premature death (Schmidt et al., 2020). Equally, community-based educational programs promote health literacy, improve individual awareness of self-management interventions, and enhance adherence to treatment options. This policy is consistent with the need to implement primary, secondary, and tertiary prevention strategies.
Finally, the Affordable Care Act (ACA) of 2010 through the Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) influences healthcare professionals’ practices and approaches for preventing, managing, and treating hypertension.
According to Witman et al. (2018), the MIPCD supports smoking cessation programs, quit attempts, and cessation counseling. These interventions focus on intercepting the causal factors for hypertension, including cigarette smoking and other forms of tobacco product use. As a result, they result in reduced mortality rates and improved community health.
Proposed Strategies to Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and Individual
Early hypertension detection, providing opportunities for physical exercise, supporting smoking cessation programs, and educating people about healthy diets are ideal strategies for preventing and controlling high blood pressure (World Health Organization, 2021).
Equally, these approaches prevent the disease’s progression, reduce care costs associated with life-threatening cardiovascular conditions and safeguard patient safety. Although these interventions are universally accepted standards for tackling hypertension, it is essential to implement tailored measures that improve care quality.
For instance, incorporating telehealth technology in hypertension prevention, treatment, and management can be an ideal strategy for alleviating health inequalities and barriers to care accessibility. Wang et al. (2021) argue that incorporating telemedicine in the management of hypertension results in multiple benefits, including timely detection of elevated blood pressure, virtual consultations, improved communication between healthcare professionals and patients, and telemonitoring.
Further, this technology can effectively address the problem of geographical barriers to care access and utilization. Therefore, it is a profound tool for improving care quality, safeguarding patient safety, and reducing the costs associated with in-office visits. When implementing the proposed interventions, the organization should establish performance metrics and utilize data to track progress and identify areas of improvement. The available and relevant sources of benchmark data include the hospital dashboard, patient medical reports, patient feedback, and surveys.
Conclusion
High blood pressure is a primary risk factor for more burdensome cardiovascular conditions, such as heart disease and stroke. These complications are the leading causes of premature deaths, increased care costs, prolonged hospitalization, and compromised quality of life. These adverse effects impact the quality of care, safety, and costs of the system.
Nursing practice standards, organizational, and governmental policies support developing collaborative care plans, respecting patients’ values and preferences, and operating in interdisciplinary teams to address hypertension. It is possible to capitalize on policy inputs by incorporating telehealth technology in the management of hypertension and educating people about the disease’s risk factors and self-management approaches.
References
Carey, R. M., Muntner, P., Bosworth, H. B., & Whelton, P. K. (2018). Prevention and control of hypertension. Journal of the American College of Cardiology, 72(11), 1278–1293. https://doi.org/10.1016/j.jacc.2018.07.008
Centers for Disease Control and Prevention. (2021, May 18). High blood pressure symptoms, causes, and problems. https://www.cdc.gov/bloodpressure/about.htm#
Centers for Disease Control and Prevention. (2022, October 3). Health topics – high blood pressure. https://www.cdc.gov/policy/polaris/healthtopics/highbloodpressure/index.html#
Haddad, L. M., & Geiger, R. A. (2022, August 22). Nursing ethical considerations. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Lawati, M. H. AL., Dennis, S., Short, S. D., & Abdulhadi, N. N. (2018). Patient safety and safety culture in primary health care: A systematic review. BMC Family Practice, 19(1), 1–12. https://doi.org/10.1186/s12875-018-0793-7
Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. Nature Reviews Disease Primers, 4(4), 18014. https://doi.org/10.1038/nrdp.2018.14
Schmidt, B.-M., Durao, S., Toews, I., Bavuma, C. M., Hohlfeld, A., Nury, E., Meerpohl, J. J., & Kredo, T. (2020). Screening strategies for hypertension. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd013212.pub2
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119
Wang, J., Li, Y., Chia, Y., Cheng, H., Minh, H. V., Siddique, S., Sogunuru, G. P., Tay, J. C., Teo, B. W., Tsoi, K., Turana, Y., Wang, T., Zhang, Y., & Kario, K. (2021). Telemedicine in the management of hypertension: Evolving technological platforms for blood pressure telemonitoring. The Journal of Clinical Hypertension, 23(3), 435–439. https://doi.org/10.1111/jch.14194
World Health Organization. (2020, July 20). Fact sheet: Quality health services. Www.who.int. https://www.who.int/news-room/fact-sheets/detail/quality-health-services
World Health Organization. (2021). Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension#