i hbpm is useful to predict cardiovascular risk. knowledge ......à trois-rivières available...
TRANSCRIPT
Graphic desing: Mireille Courteau
Background Literature Objectives Methods
ResultsDiscussion
Recommendations
Conclusion
References
43
57
52
48
30
48
91
9
91
54
46
23
77
23
69
62
38
69
42
58
58
42
21
71
75
25
63
Gender
Men
Women
Age
< 40 years old*
> 41 years old*
Education
Collegial**
University**
Employment
Full time**
Partial time**
Has a family doctor **
Sociodemographic characteristicsSociodemographic characteristics
Individual(n=23)
(%)
Group(n=13)
(%)
Self-learning(n=24)
(%)
* Difference between three groups, p = 0,004 ** Difference between three groups, p <0,0001
i Hypertension (HTN) is one of the most important risk factor of cardiovascular disease.1
i 19% of Canadian adults have HTN.2
i Three different methods can be used to measure blood pressure:
l Office blood pressure measurement
l Ambulatory blood pressure monitoring (ABPM)
l Home blood pressure measurement (HBPM)
i HBPM is popular among hypertensive patients.3
i Learning and using a validated protocol for HBPM is essential to get valid measurements.4
i Hypertension (HTN) is one of the most important risk factor of cardiovascular disease.1
i 19% of Canadian adults have HTN.2
i Three different methods can be used to measure blood pressure:
l Office blood pressure measurement
l Ambulatory blood pressure monitoring (ABPM)
l Home blood pressure measurement (HBPM)
i HBPM is popular among hypertensive patients.3
i Learning and using a validated protocol for HBPM is essential to get valid measurements.4
i HBPM is useful to predict cardiovascular risk.5
i HBPM eases detection of white coat HTN6 and masqued HTN.7
i HBPM improves therapeutic observance8 and blood pressure control.9
i Educative programs: two studies.iArmstrong et al. (1995)- Design: pre-experimental post-test only- N= 30- Individual HBPM educative program lasting 45 minutes - Auscultatory technique- Good results in knowledge and practice evaluation
iStryker et al. (2004)- Design: pre-experimental pre-test post-test - N= 80- Individual HBPM educative program lasting 10 minutes - Oscillometric technique- Improvement in practice
i Framework: CHEP (Canadian Hypertension Education Program ) was used for knowledge and practice evaluation.4
i HBPM is useful to predict cardiovascular risk.5
i HBPM eases detection of white coat HTN6 and masqued HTN.7
i HBPM improves therapeutic observance8 and blood pressure control.9
i Educative programs: two studies.iArmstrong et al. (1995)- Design: pre-experimental post-test only- N= 30- Individual HBPM educative program lasting 45 minutes - Auscultatory technique- Good results in knowledge and practice evaluation
iStryker et al. (2004)- Design: pre-experimental pre-test post-test - N= 80- Individual HBPM educative program lasting 10 minutes - Oscillometric technique- Improvement in practice
i Framework: CHEP (Canadian Hypertension Education Program ) was used for knowledge and practice evaluation.4
1 - KnowledgeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on knowledge.
2 - PracticeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on practice.
1 - KnowledgeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on knowledge.
2 - PracticeEvaluation in adults of the impact of three HBP educative program : individual training, group training and self-learning on practice.
i Pre-test post-test with 3 random groups.
i Pre-test: knowledge evaluation with question-naire (12 questions).
i Post-test: practice evaluation with observation grid (8 observations) and knowledge evaluation of with same questionnaire than pre-test.
i Convenient sampling among university adult workers.
i Pre-test post-test with 3 random groups.
i Pre-test: knowledge evaluation with question-naire (12 questions).
i Post-test: practice evaluation with observation grid (8 observations) and knowledge evaluation of with same questionnaire than pre-test.
i Convenient sampling among university adult workers.
UQTR ethic certificate no CER–09-147-07.07
Knowledge
i For knowledge, scores achieved in post-test for individual training, group training and self-learning are = 90% (97%, 99% and 90% respectively).
i Scores achieved in post-test evaluation are better than scores obtained in pre-test (38%, 54% and 45% respectively; p < 0,000).
i Scores reached with self-learning educative program are below the average of individual and group training scores (p = 0,01).
i The least successful answers are related to threshold value and rest period needed before measurement.
Practice
i For practice, scores achieved in post-test for individual training, group training and self-learning are 74%, 79% and 53% respectively.
i Scores reached with self-learning educative program are inferior to individual and group training results (p= 0,01).
i The least successful observations are related to back position, rest period, talking during measurement and second measurement. Rest period is also an observation with poor scores in another study about HBPM.11
Strenghts
i It’s the first study realised in Quebec about HBP educative programs with knowledge and practice evaluation of adult workers.
i A HBPM educative program can be realised in 10 minutes with knowledge improvement in short delays.
Limits
i Results cannot be generalised to general population because of the small sample and the inequal sociodemographic characteristics between groups.
i Low scores obtained in practice evaluation can be a consequence of laboratory condition.
Knowledge
i For knowledge, scores achieved in post-test for individual training, group training and self-learning are = 90% (97%, 99% and 90% respectively).
i Scores achieved in post-test evaluation are better than scores obtained in pre-test (38%, 54% and 45% respectively; p < 0,000).
i Scores reached with self-learning educative program are below the average of individual and group training scores (p = 0,01).
i The least successful answers are related to threshold value and rest period needed before measurement.
Practice
i For practice, scores achieved in post-test for individual training, group training and self-learning are 74%, 79% and 53% respectively.
i Scores reached with self-learning educative program are inferior to individual and group training results (p= 0,01).
i The least successful observations are related to back position, rest period, talking during measurement and second measurement. Rest period is also an observation with poor scores in another study about HBPM.11
Strenghts
i It’s the first study realised in Quebec about HBP educative programs with knowledge and practice evaluation of adult workers.
i A HBPM educative program can be realised in 10 minutes with knowledge improvement in short delays.
Limits
i Results cannot be generalised to general population because of the small sample and the inequal sociodemographic characteristics between groups.
i Low scores obtained in practice evaluation can be a consequence of laboratory condition.
Practice
i HBP educative program can be achieved in less than 15 minutes by a nurse and can improve knowledge and practice immediatly after attainment.
i Written documentation alone is not sufficient for knowledge acquisition. Interaction between patients and health professionals that can make demonstrations and answer questions is more efficient.
Research
i Repeat evaluations in 3 months to verify educative program effect on knowledge and practice retention.
i Pursue experimentation with educative programs on specific populations (exclusively HTN, different levels of education, etc.).
Practice
i HBP educative program can be achieved in less than 15 minutes by a nurse and can improve knowledge and practice immediatly after attainment.
i Written documentation alone is not sufficient for knowledge acquisition. Interaction between patients and health professionals that can make demonstrations and answer questions is more efficient.
Research
i Repeat evaluations in 3 months to verify educative program effect on knowledge and practice retention.
i Pursue experimentation with educative programs on specific populations (exclusively HTN, different levels of education, etc.).
i All HBP educative programs used in this study increase knowledge and practice.
i Individual and group training are more efficient than self-learning educative program, especially for practice.
i All HBP educative programs used in this study increase knowledge and practice.
i Individual and group training are more efficient than self-learning educative program, especially for practice.
Université du Québec à Trois-Rivières
available population : 1349
Sample:95 subjects
Withdrawal of 18 subjects
Withdrawal of 8 subjects
Randommization
Self-learning:32 subjects
Individual training:
32 subjects
Group training:
31 subjects
Self-learning:n=24
Individual training:n=23
Group training:n=13
Withdrawal of 9 subjects
1 - Knowledge1 - Knowledge
2 - Practice2 - Practice
** Score difference between three groups, p < 0,0001
* p < 0,0001
Knowledge scores (%)Knowledge scores (%)
0
20
40
60
80
100
pre-test
post-test**
Self-learning* n=24
Group* n=13
Individual* n=23
p= 0,01
p= 0,274 p= 0,01
97 99
90
38
54
45
knowledge (%)
Educative programs
* Score difference between three groups, p <0,0001
post-test*
Practice scores (post-test only) (%)Practice scores (post-test only) (%)
Self-learning n=24
Group n=13
Individual n=23
0
10
20
30
40
50
60
70
80
p= 0,01
p= 0,397 p= 0,01
74
79
53
practice (%)
Educative programs
1. Yusuf, S., Hawken, S., Ounpuu, S., Dans, T., Avezum, A., Lanas, F., and al. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancand, 364 (9438), 937-952.
2. Wilkins, K., Campbell, N. R. C., Joffres, M. R., McAlister, F. A., Nichol, M., Quach, S., et al. (2010). Tension artérielle des adultes au Canada. Statistique Canada, No 82-003-X au catalogue, Rapports sur la santé, 21 (1).
3. Lopez, L. M., & Taylor, J. R. (2004). Home blood pressure monitoring: point-of-care testing. The Annals Of Pharmacotherapy, 38 (5), 868-873.
4. Padwal, R. S., Hemmelgarn, B. R., Khan, N. A., Grover, S., McKay, D. W., Wilson, T., and al. (2009). The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1--blood pressure measurement, diagnosis and assessment of risk. The Canadian Journal Of Cardiology, 25 (5), 279-286.
5. Bobrie, G., Chatellier, G., Genes, N., Clerson, P., Vaur, L., Vaisse, B., and al. (2004). Cardiovascular Prognosis of "Masked Hypertension" dandected by blood pressure self-measurement in elderly treated hypertensive patients. Journal of American Medical Association, 291(11), 1342-1349.
6. Stergiou, G. S., Skeva, II, Baibas, N. M., Kalkana, C. B., Roussias, L.
G., & Mountokalakis, T. D. (2000). Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements. Journal Of Hypertension, 18 (12), 1745-1751.
7. Terawaki, H., Mandoki, H., Nakayama, M., Ohkubo, T., Kikuya, M., Asayama, K., and al. (2008). Masked hypertension dandermined by self-measured blood pressure at home and chronic kidney disease in the Japanese general population: the Ohasama study. Hypertension Research: Official Journal Of The Japanese Sociandy Of Hypertension, 31 (12), 2129-2135 .
8. Ogedegbe, G., & Schoenthaler, A. (2006). A systematic review of the effects of home blood pressure monitoring on medication adherence.
The Journal of Clinical Hypertension, 8, 174-180.
9. Cappuccio, F. P., Kerry, S. M., Forbes, L., & Donald, A. (2004). Blood pressure control by home monitoring: manda-analysis of randomised trials. BMJ (Clinical Research Ed.), 329 (7458), 145-148
10. Armstrong, R., Barrack, D., & Gordon, R.(1995). Patients achieve accurate home blood pressure measurement following instruction. Australian Journal of Advanced Nursing, 12(4), 15-21.
11. Stryker, T., Wilson, M., & Wilson, T. W. (2004). Accuracy of home blood pressure readings: monitors and operators. Blood Pressure Monitoring, 9 (3), 143-147.
Proportion of good answers (pre-test post-test)Proportion of good answers (pre-test post-test)
100
100
91
100
96
100
96
96
100
100
100
87
52 4
35 4
39 4
91 4
61 4
26 4
17 4
13 4
17 4
13 4
83 4
9 4
100
100
100
100
100
100
100
100
100
100
100
92
62 4
46 4
46 4
92 4
69 4
54 4
46 4
23 4
38 4
31 4
100 4
38 4
92
100
79
100
88
92
88
92
88
88
96
75
38 4
63 4
42 4
88 4
46 4
42 4
38 4
21 4
38 4
21 4
92 4
13 4
Cuff size
Impact of meal
Rest period
Body position
Arm position
Difference of pressure between arms
Need to use washroom before measurement
Number of measurement
Time of the day for measurement
Number of days for measurement
Recording
Threshold value at home
Question Individual(n=23)
group(n=13)
Self-learning(n=24)
pré-test 4 post-test ( %)
Proportion of good observations (post-test only)Proportion of good observations (post-test only)
39
96
74
96
50
78
74
91
46
100
92
92
92
85
62
92
33
88
38
83
13
63
39
71
Rest period
Arm preparation
Talking during measurement
Avoid moving during measurement
Back supported
Feet on the floor
Second measurement
Arm support at heart level
Observation Individual(n=23)
Group(n=13)
Self-learning(n=24)
post-test only ( %)
HOME BLOOD PRESSURE EDUCATIVE PROGRAMS : impact on adult knowledge and practice
Marie-Ève Leblanc RN BN�Lyne Cloutier RN PhD
Department of Nursing, �Université du Québec à Trois-Rivières
AcknowledgementsHome blood pressure automatic machines
used in project (3AG1 model) come from