Lafrance, Herard

Background: Hypertension (HTN) is one of the leading causes of death in the United States. It is an all too common disease that goes unnoticed and untreated until it is too late. African American adults suffer from uncontrolled hypertension at a disproportionate rate when compared to their Caucasian or Latinx counterparts, and hypertension continues to be a persistent issue within a primary care setting when dealing with this population.
Purpose: This Doctor of Nursing Practice (DNP) project assesses the effectiveness of combating hypertension by giving participants the knowledge to improve their condition, continually monitoring blood pressure, and providing counseling at various follow-up sessions. The primary goal of this project was to decrease the blood pressure of all participants and increase participants’ education on how to better manage their condition.

Medication non-adherence constitutes a significant barrier to the effective management of diabetes and can place a severe burden on healthcare system. Despite the development of new medications, diabetes remains the 7th leading cause of death in the United States (Hirsch et al.,2021). This quality improvement project was conducted in a primary care setting to assess and improve medication adherence.in adults with diabetes. The adherence to medication was measured by the Adherence Starts with Knowledge-12(ASK-12) survey. The interventional strategies included medication-specific education, self-management of glucose monitoring, and a follow-up program using telephone calls, text messages, or mobile health applications. A total of eighteen eligible participants' ((72.2% female; mean age 62.06 y; 94.4% Afro-Caribbeans) ASK-12 questionnaire scores (pre and post) and Hemoglobin A1c (HgA1c) (pre and post) level were used for final data analysis. A paired sample t-test of ASK-12 scores demonstrated an improvement in medication adherence, from an average of (M=30.28, SD=6.28) on the pre-test to (M=14.39, SD=2.15) on the post-test [t (17) =12.14, p < 0.001, Cohen’ d=2.86]. A paired sample t-test of HgA1c results were also statistically significant with a decrease of the HgA1c from an average of (M= 9.1, SD=1.76) on the pre-test to M=7.9, SD=1.14) on post-test, [t (17) =5.49, p < 0.001, Cohen’s d =1.293]. This project highlights the positive impact of routine monitoring, medication-specific education, and follow-up reminders on improving medication adherence and glycemic control.

Background: Hypertension (HTN) is a very common, undertreated, and costly disease. Despite effective treatment strategies available, uncontrolled hypertension remains a persistent problem in the primary care setting.
Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to assess the effectiveness of a walking exercise program (WEP) on blood pressure in adults diagnosed with uncontrolled hypertension in a primary care setting. Goals were targeted to decrease blood pressure, decrease BMI, and increase physical activity.
Methods: Using Bandura’s Social Cognitive theory as a framework, a walking exercise was offered at a primary care clinic, to assess the effectiveness of exercise in reducing blood pressure. Fourteen (N=14) participants enrolled and completed the 8-week program. Blood pressure and body mass index (BMI) were measured prior to intervention (pre), 4-weeks after (mid), and at 8 weeks (post). Participants were given a pedometer to calculate steps walked daily, and a paper log for blood pressure and steps recording.
Results/Interpretations: Systolic blood pressure (SBP) was significantly reduced (p=.001). Diastolic blood pressure (DBP) also had a statistically significant reduction (p=.049). BMI was also significantly reduced (p=.037) when compared to pre intervention.
Implication: This quality improvement (QI) project showed that the implementation of a walking exercise program in a primary care setting can lead to significant improvements in blood pressure management.