NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Name

Capella university

NURS-FPX 6030 MSN Practicum and Capstone

Prof. Name

Date

Problem Statement (PICOT)

Hypertension is an alarmingly prevalent chronic condition among aging populations. This condition affects individuals and burdens society with preventable morbidity and mortality. This widespread condition demands a comprehensive approach integrating innovative prevention, early detection strategies, and evidence-based management tailored to individual needs. This assessment builds on the PICOT question, particularly on hypertension for the aging population, and to mitigate the impact of hypertension on the population suffering from this condition. The PICOT question is: In elderly adults aged 65 and above with diagnosed hypertension (P), does access to telemedicine services (I) compared to in-person consultations (C) lead to improved management of hypertension and reduction in hospital readmission rates (O) over six months (T)?

Need Assessment

The project addresses a critical quality improvement need in hypertension management among elderly adults aged 65 and above. This demographic is at a heightened risk of hypertension-related complications, including cardiovascular events and organ damage. Roughly 1.28 billion adults between the ages of 30 and 79 globally are affected by hypertension, with the majority, approximately two-thirds, residing in low- and middle-income nations (WHO, 2023). This underscores the urgency of implementing effective management strategies. Additionally, hypertension imposes a financial burden on the country, amounting to approximately $131 to $198 billion annually, further emphasizing the imperative to improve management practices (CDC, 2021).

The current rate of 30-day hospital readmissions for elderly people with hypertension accounts for 8.5%, with 22.9% of cases due to poor management of hypertension (Brunner-La Rocca et al., 2020). Considering these baseline data, it is crucial to address this issue and evaluate the success of this project by measuring the reduction in hospital readmission rates.   The assumptions are that the epidemiological data on global hypertension prevalence and its distribution across income levels and the financial burden estimates provided by organizations like the CDC are accurate and reliable for informing the need for quality improvement in hypertension management. By addressing this pressing need, the project aims to significantly enhance the quality of care, prevent complications, and notably improve health outcomes for elderly individuals with hypertension.

Population and Setting

The target population for the project is elderly adults aged 65 and above who are diagnosed with hypertension. It is crucial to address the identified need within this population because they are at a heightened risk of hypertension-related complications, including cardiovascular events and organ damage. Additionally, this demographic often faces challenges in accessing healthcare services and adhering to treatment regimens, making effective management strategies imperative to improve health outcomes and quality of life (WHO, 2023).

The setting targeted for the project is Senior Health Services (SHS), which aims to provide comprehensive healthcare services for seniors; we can leverage their existing infrastructure and expertise to seamlessly integrate the telemedicine intervention into their workflow. Additionally, SHS can develop tailored approaches to ensure consistent follow-up and adherence to treatment plans among elderly patients with hypertension. The project can effectively reach and engage the target population by leveraging this setting, ultimately improving hypertension management outcomes.

Quality Improvement Method

Implementing a Plan-Do-Study-Act (PDSA) quality improvement method, the project could impact patient outcomes by systematically evaluating the effectiveness of telemedicine interventions for hypertension management in elderly adults aged 65 and above. This iterative approach allows continuous refinement of interventions based on real-world data and feedback, potentially leading to improved blood pressure control rates and overall health outcomes (Haffenden-Morrison, 2022). However, SHS may encounter challenges related to technology literacy among its elderly patient population with hypertension. Many seniors may need to become more familiar with telemedicine platforms or need access to devices and the internet. Additionally, elderly people with hypertension receiving care at SHS may express concerns about privacy and confidentiality when engaging in telemedicine appointments (Caballero et al., 2023).

Intervention Overview

One intervention to address the identified need for hypertension management in elderly adults aged 65 and above is the implementation of telemedicine services tailored explicitly for remote monitoring and consultation. This intervention provides access to telehealth platforms where patients can remotely measure their blood pressure using home monitoring devices and virtual consultations with healthcare providers for medication adjustments, lifestyle counseling, and treatment adherence support (Caballero et al., 2023). While telemedicine offers the convenience of remote access to healthcare services and may improve patient engagement, the weaknesses include ensuring technology access and proficiency among elderly individuals addressing concerns about privacy and confidentiality in virtual consultations.

Moreover, the telemedicine strategy has a weakness in overcoming barriers to consistent follow-up and adherence to treatment plans, particularly in populations with limited digital literacy or access to technology. Additionally, the effectiveness of telemedicine interventions may vary depending on the availability of resources and support systems within the target setting, necessitating careful consideration of implementation strategies and ongoing monitoring of outcomes (Caballero et al., 2023).

Comparison of Approaches

An interprofessional alternative to telemedicine remote monitoring and consultations for hypertension management in elderly adults 65 and above is in-person consultations involving a multidisciplinary healthcare team. In-person consultations allow for comprehensive assessments, including physical examinations and face-to-face interactions, which may enhance rapport-building and patient-provider communication. Additionally, direct observation of patients’ behavior and health status may facilitate more accurate diagnoses and treatment decisions (Wong et al., 2021).

However, in-person consultations may pose challenges related to accessibility, particularly for elderly individuals with mobility limitations or residing in remote areas. Moreover, scheduling and travel logistics may be burdensome for patients, leading to potential barriers to accessing timely care. Additionally, in-person consultations may require increased healthcare resources and incur higher costs than telemedicine interventions. Thus, while in-person consultations offer advantages regarding comprehensive assessments and interpersonal interactions, they may not fully address the accessibility and convenience needs of the target population, especially within community-based healthcare settings (Wong et al., 2021).

Initial Outcome Draft

The outcome of the intervention is aimed at reducing the rate of hospital readmissions due to hypertension among elderly individuals at SHS. This initiative seeks to improve this demographic’s overall quality of care and health outcomes by implementing targeted interventions to enhance hypertension management practices (Caballero et al., 2023). The intended accomplishments include improving medication adherence, implementing lifestyle modifications, and leveraging telemedicine interventions to provide timely support and interventions. Decreasing the need for hospital readmissions can alleviate the burden on healthcare facilities and resources while minimizing the disruptions and complications associated with hospitalizations for hypertension-related issues.

The criteria for evaluating the achievement of this outcome involve comparing baseline data on 30-day hospital readmission rates (8.5%) for elderly individuals with hypertension, particularly those attributed to poor management of hypertension (Brunner-La Rocca et al., 2020). Success will be measured by a significant reduction in the rate of hospital readmissions by 20%, coupled with improvements in hypertension management practices such as better blood pressure control. Through these measures, the intervention aims to enhance the overall well-being and quality of life of elderly individuals managing hypertension, thereby contributing to improved healthcare outcomes and resource utilization.

Time Estimate

Over six months, developing and implementing a telemedicine intervention for hypertension management among elderly adults will proceed through several key stages. Initially, during the first two months, comprehensive planning and needs assessments will be conducted to identify specific requirements and challenges. This phase will define the intervention’s scope, objectives, and necessary resources while establishing crucial partnerships with healthcare providers and telemedicine platforms. Subsequently, the intervention will be actively developed in months three and four, creating tailored protocols, guidelines, and training programs for healthcare providers.

Special attention will be given to customizing telemedicine platforms to ensure accessibility and user-friendliness for elderly users. Finally, the intervention will be rolled out to the target population in the last two months, starting with a pilot test to refine protocols and then expanding to broader implementation. Throughout the process, ongoing monitoring and evaluation will occur to assess utilization rates, patient satisfaction, and healthcare outcomes. This will allow for adjustments to optimize the intervention’s effectiveness and sustainability in addressing hypertension management needs among elderly adults.

Literature Review

The need to introduce telemedicine for hypertension management among elderly patients is adequately substantiated by evidence-based resources in the literature. According to Caballero et al. (2023), telemedicine effectively managed hypertension in elderly people during the COVID-19 pandemic. This resource also highlighted that telemedicine facilities enhanced the follow-up rates to 58%. Another review article by Citoni et al. (2021) stressed the use of telemedicine and home blood pressure management along with its benefits and limitations.

The resource found that telemonitoring of BP decreased elevated blood pressure to the normal range among the intervention group with p < 0.001. The article by Wulan et al. (2023) utilized telemedicine for elderly patients with hypertension and diabetes mellitus in Indonesia. This article recommends the use of telemedicine for elderly patients with hypertension. Li et al. (2022) also researched using telemedicine features with mobile applications for managing hypertension among elderly patients using pharmacist-led management plans. This resource showed that BP control rates were reduced to 63% with p < 0.001. Moreover, the patient satisfaction scores of five points accounted for 99.3% of patients.    

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

According to Mabeza et al. (2022), telemedicine was considered equal to clinical visits for managing hypertension, and they suggest using telemedicine to treat chronic diseases like hypertension. The article by Hawlik et al. (2021) found that telemedicine is a promising and modern approach fruitful in times like the global pandemic, where in-person care is limited. The research article by Fujiwara et al. (2023) evaluated the effectiveness of BP telemonitoring among the aging population in Japan and found that this strategy helps promote adherence to hypertensive treatment and management plans. A systemic review by Ma et al. (2022) delved into telemedicine applications helpful in managing chronic diseases like hypertension with positive improvements in systolic blood pressure.

According to Omboni (2022), the use of telemedicine approaches, such as wearable to monitor BP and virtual consultation, has improved the management of hypertension.  Lastly, Fujiwara et al. (2022) also discussed the role of telemedicine in managing hypertension and future perspectives in improving this condition in the elderly age group. These evidence-based resources are selected based on CRAAP criteria, including Currency, Relevance, Authority, Accuracy, and Purpose. All the cited articles have been published within the last five years. Moreover, the subject of all these articles is relevant to telemedicine for hypertension management. Lastly, the articles provide accurate information enhancing their trustworthiness and sufficiency. 

Evaluation and Synthesis of Relevant Health Policies

The Health Insurance Portability and Accountability Act (HIPAA) policy plays a crucial role in shaping the use of telemedicine for hypertension management among elderly individuals. HIPAA regulations mandate the protection of patients’ privacy and confidentiality, ensuring the secure handling of their health information, including during telemedicine consultations. Compliance with HIPAA guidelines is essential when implementing telemedicine solutions, as failure to adhere to these regulations can result in significant penalties and legal consequences (Jin et al., 2020).

However, there may need to be more information related to how HIPAA applies specifically to telemedicine practices, such as guidance on the secure transmission of electronic health records, authentication of telemedicine platforms, and patient consent procedures for virtual consultations. Further clarification may be needed regarding the jurisdictional variations in telemedicine regulations and how they intersect with HIPAA requirements, particularly in cases involving interstate telemedicine consultations (Jin et al., 2020). Addressing these gaps in information is essential for ensuring the effective and lawful implementation of telemedicine for hypertension management among elderly populations while maintaining compliance with HIPAA policies.

Conclusion

In conclusion, our discussion underscores the vital role of telemedicine in addressing hypertension management needs among elderly adults. Integrating telemedicine into SHS can enhance accessibility and improve health outcomes by reducing hospital readmission rates. However, adherence to regulations like HIPAA is essential to protect patient privacy. Despite the potential of telemedicine, further clarity is needed on its intersection with HIPAA and patient consent procedures.

References

Brunner-La Rocca, H.-P., Peden, C. J., Soong, J., Holman, P. A., Bogdanovskaya, M., & Barclay, L. (2020). Reasons for readmission after hospital discharge in patients with chronic diseases—Information from an international dataset. PLOS ONE, 15(6), e0233457. https://doi.org/10.1371/journal.pone.0233457 

Caballero, M. Q., García, A. C., Peña, S. C., Caballero-Mateos, A. M., Martín, O. F., Cañadas-De la Fuente, G. A., & Romero-Bejar, J. L. (2023). Telemedicine in elderly hypertensive and patients with chronic diseases during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Clinical Medicine, 12(19), 6160. https://doi.org/10.3390/jcm12196160 

CDC. (2021, March 3). Health topics – high blood pressure – POLARIS. Centers for Disease Control and Prevention. https://www.cdc.gov/policy/polaris/healthtopics/highbloodpressure/index.html 

Citoni, B., Figliuzzi, I., Presta, V., Volpe, M., & Tocci, G. (2021). Home blood pressure and telemedicine: A modern approach for managing hypertension during and after COVID-19 pandemic. High Blood Pressure & Cardiovascular Prevention, 29(1). https://doi.org/10.1007/s40292-021-00492-4 

Fujiwara, T., McManus, R. J., & Kario, K. (2022). Management of hypertension in the digital era: Perspectives and future directions. Hipertensión Y Riesgo Vascular, 39(2), 79–91. https://doi.org/10.1016/j.hipert.2022.01.004 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Fujiwara, T., Sheppard, J. P., Hoshide, S., Kario, K., & McManus, R. J. (2023). Medical telemonitoring for the management of hypertension in older patients in Japan. International Journal of Environmental Research and Public Health, 20(3), 2227. https://doi.org/10.3390/ijerph20032227 

Haffenden-Morrison, C. (2022). The use of telemedicine in primary care to improve medication adherence: Quality improvement project. DNP Projects. https://digitalcommons.sacredheart.edu/dnp_projects/19/ 

Hawlik, M. H., Moran, A., Zerihun, L., Usseglio, J., Cohn, J., & Gupta, R. (2021). Telemedicine interventions for hypertension management in low- and middle-income countries: A scoping review. PLOS ONE, 16(7), e0254222. https://doi.org/10.1371/journal.pone.0254222 

Jin, M. X., Kim, S. Y., Miller, L. J., Behari, G., & Correa, R. (2020). Telemedicine: Current impact on the future. Cureus, 12(8), e9891. https://doi.org/10.7759/cureus.9891 

Li, Q., Yang, L., Zheng, T., Han, S., Yang, S. X., Lin, P., Liang, J., Zhang, T., Liu, S., Zhang, W., & Zhen Jian-cun. (2022). Pharmacist-led telemedicine disease management based on mobile application for elderly patients with hypertension: A self-controlled case series study. Research Square. https://doi.org/10.21203/rs.3.rs-2019517/v1 

Ma, Y., Zhao, C., Zhao, Y., Lu, J., Jiang, H., Cao, Y., & Xu, Y. (2022). Telemedicine application in patients with chronic disease: A systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 22(1). https://doi.org/10.1186/s12911-022-01845-2 

NURS FPX 6030 Assessment 2 Problem Statement (PICOT)

Mabeza, R. M. S., Maynard, K., & Tarn, D. M. (2022). Influence of synchronous primary care telemedicine versus in-person visits on diabetes, hypertension, and hyperlipidemia outcomes: A systematic review. BMC Primary Care, 23(1). https://doi.org/10.1186/s12875-022-01662-6 

Omboni, S. (2022). Telemedicine for hypertension management: Where we stand, where we are headed. Connected Health, 1(2), 85–97. https://doi.org/10.20517/ch.2022.09 

WHO. (2023). Hypertension. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hypertension 

Wong, S. H., Barrow, N., Hall, K., P Gandesha, & Manson, A. (2021). The effective management of idiopathic intracranial hypertension delivered by in-person and virtual group consultations: Results and reflections from a phase one service delivery. Neuro-Ophthalmology, 45(4), 246–252. https://doi.org/10.1080/01658107.2021.1887287 

Wulan, W. R., Widianawati, E., Pantiawati, I., & Wulandari, F. (2023). Telemedicine homecare among the hypertension and diabetes mellitus risk elderly group in Indonesian primary healthcare: A technology acceptance model. Home Health Care Management & Practice, 36(2). https://doi.org/10.1177/10848223231195638