Care Coordination Plan based on Primary Hypertension

Primary Hypertension Care Coordination Plan

Over the past decade, healthcare professionals have expressed growing concern over the marked increase in cases of primary hypertension across the American population. They continue to urge the U.S. Department of Health and Human Services (HHS) this threat given that it is serious public health concern. Primary hypertension is typically referred to as the “silent killer” since it often has no presenting symptoms and can remain undetected for an extended period among individuals with the condition.

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According to recent data provided by the Centers for Disease Control and Prevention (CDC), approximately 103 million adults in the U.S. suffer from primary hypertension, with the prevalence expected to increase annually (Centers for Disease Control and Prevention, 2022). The condition is more common among African Americans, compared to their White Caucasian counterparts, and also affects more men than women in the general population. A care coordination plan for primary hypertension is, therefore, fundamental in the grand scheme of healthcare improvement since it provides a plan of action for effective management and treatment of the condition.

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Health Issues, Interventions, and Timelines for Primary Hypertension

Monitoring and Tracking of Blood Pressure

Intervention

Proper monitoring and tracking of blood pressure is among one of the most important activities for individuals diagnosed with primary hypertension. This process often ensures that they frequently check for fluctuations in blood pressure and are, therefore, able to seek appropriate medical help when required. Regular monitoring and tracking of blood pressure can be achieved by providing patients with home blood pressure monitoring devices for personal use. However, this process should always be preceded by patient education to ensure that the patient is eventually able to use the monitor correctly.

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Timeline

The patient should also be encouraged to check their blood pressure regularly to ensure that any emerging issue of concern is identified and met with the appropriate response. They should also focus on keeping a log of their readings to ensure they have an appropriate reference point when assessing blood pressure levels and determining whether they require medical attention. Patients should typically check their blood pressure levels at least twice a week while always remembering to bring the log to future appointments for evaluation by the healthcare provider.

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Diet and Nutrition Counseling

Intervention

Maintaining a healthy and nutritious diet is often regarded as one of the most critical elements to consider in the management of hypertension. A healthy diet goes a long way in ensuring that an individual maintains a healthy mass. This is among one of the reasons why diet and nutrition counseling has become one of the most highly sought-after interventions for hypertension. Diet and nutrition counseling begins with comprehensive patient education to ensure the patient understands the causes and risk factors responsible for their condition, in addition to viable interventions (Kapur & Mattoo, 2018). Primary health care providers usually provide information on Dietary Approaches to Stop Hypertension (DASH) to lay the groundwork for diet and nutrition counseling.

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Timeline

Diet and nutrition counseling should always be provided after a formal diagnosis is made. Patient education should then follow as an important avenue for direct communication with the patient on types of foods likely to worsen their current condition and proper management strategies. The patient should be advised to make immediate changes to their current data and constantly monitored by close family members. Follow-up sessions should also be scheduled every 3-6 months after the initial diagnosis and conducted by the primary care provider.

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Exercise and Physical Activity

Intervention

Primary hypertension has often been linked to lifestyle choices and is mostly attributed to a sedentary lifestyle characterized by inactivity.  According to Kapur & Mattoo (2018), the condition can be managed appropriately by introducing exercise and physical activity with the primary aim of improving individual’s overall quality of life. The primary care provided should, therefore, provide relevant advice on how to develop a plan for exercise and physical activity tailored to patient’s specific needs and requirements.

Timeline

A regular exercise regimen should be adopted by patients diagnosed with primary hypertension and executed on a regular basis. Patients should also be provided with relevant resources on exercise and physical activity to boost their overall understanding of the steps needed to succeed in this journey. It should be incorporated into their daily routine and remain part activity plan for the foreseeable future. Progress made should be evaluated every two months while also evaluating changes noted in health status and blood pressure levels.

Ethical Decisions in Designing Patient Centered Health Interventions

The process involved in the actual designing of patient-centered health interventions should always involve ethical considerations to guarantee relevant concerns are always addressed. This would typically involve prioritizing patient’s individual preferences and needs while also ensuring that the intervention in question also seeks to improve their quality of life. Autonomy is, arguably, one of the most important philosophies influencing ethical decisions today. This principle acknowledges that patients have the right to make individual decisions on issues associated with their health and any proposed interventions. Healthcare providers are, therefore, generally expected to acknowledge patient’s autonomy during treatment and are expected to support and respect decisions made (Kanoti, 2019).

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They are also expected to conduct comprehensive patient education to ensure patients are fully informed about their decisions, available interventions, and the potential risks and benefits of each option. Beneficence is also an important ethical principle and is often prioritized when designing patient-centered health interventions. This ethical decision has practical effects on the quality of interventions provided since it provides that proposed solutions should always be based on sound empirical evidence. Moreover, it is crucial to also assess the ethical questions that generated uncertainty regarding the decisions made in the management of primary hypertension. It was paramount to weigh the risks and benefits of each intervention to create a framework treatment option do not harm patients. Justice is also crucial in the designing of designing of patient-centered health interventions given that they should always be accessible to all patients regardless of the insurance coverage status or location.

Health Policy Implications and Continuum of Care

The coordination and continuum of care has always been known to support continuity in the healthcare system. Health policies geared towards this specific aim also attempt to improve the quality-of-care delivery as is commonly the case with the Affordable Care Act (ACA) of 2010. This particular health policy contains specific clause that focus exclusively on coordination and continuity of care for vulnerable population groups across the United States. For instance, the ACA led to the formal creation of the Accountable Care Organizations (ACOs) whose primary objective was to coordinate care plans across the different patient groups at a state and national level. The ultimate intention of ACOs was to improve the overall quality of care on offer while ensuring that patients receive healthcare services at reduced costs. Additionally, ACOs also led to the creation of the Medicaid Primary Care Payment Increase provision whose main aim is to increase reimbursement rates associated with some of the main primary care services (Hofbauer & Bönner, 2016). Patients suffering from primary hypertension can benefit greatly from these provisions given that they are specifically designed to improve access to primary care services. Complex care programs typically tend to improve the overall quality of care on offer while fostering efficiency through the adoption and implementation of novel developments such as the electronic health records (EHR).

Priorities for Care Providers when Discussing the Primary Hypertension Care Coordination Plan

Primary care providers have a clear obligation to discuss a care plan with a patient and family member(s) while also making much-needed changes to the intervention based primarily on evidence-based practice. Today, primary hypertension care coordination plans have often featured the regular monitoring of blood pressure, exercising frequently, and making drastic lifestyle changes such as adopting a healthier diet plan. These plans are often augmented with appropriate medications prescribed by an accredited healthcare provider. It is also important to note that improved patient outcomes are only noted when the patients are subjected to regular follow-up sessions to track progress while making necessary changes to the treatment plan. Furthermore, a primary hypertension care coordination plan may also involve offering relevant resources through patient education programs to improve individual’s knowledge of the condition and how to manage it while including family members (Healthy People 2030, 2021). A care coordinator must also prioritize effective communication and coordination with the healthcare team to ensure they are all aware of patients’ care plan and are collaborating to achieve set treatment goals.

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