Key result
A more favorable clinical practice environment perceived by nurses and increased patient-nurse consultations were associated with a significant reduction in poor high-blood pressure control (OR 0.99).
Why the study?
Do favorable primary care nursing workforce characteristics and clinical practice environments improve high blood pressure control in hypertensive patients?
Cross-Sectional (n=76,797)
Yes
Do favorable primary care nursing workforce characteristics and clinical practice environments improve high blood pressure control in hypertensive patients?
A favorable clinical practice environment for primary care nurses and increased patient-nurse consultations are associated with better high blood pressure control.
Nursing environments were associated with better BP control; hypothesis-generating for interventions, with prospective trials needed before practice change.
OBJECTIVE: To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP). DESIGN: Cross-sectional analytical study. SETTING: Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses. PARTICIPANTS: 76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. PRIMARY OUTCOME MEASURE: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE. RESULTS: The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99). CONCLUSIONS: A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed.
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Parro‐Moreno et al. (2015) conducted a cross-sectional in High-blood pressure (hypertension) (n=76,797). Favorable clinical practice environment (CPE) and increased patient-nurse consultations vs. Less favorable CPE and fewer consultations was evaluated on Poor high-blood pressure control (mean measurements ≥140/90 mm Hg) (OR 0.99, 95% CI 0.98-0.99, p=≤0.05). A more favorable clinical practice environment perceived by nurses and increased patient-nurse consultations were associated with a significant reduction in poor high-blood pressure control (OR 0.99).
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