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What is Hypertension?

Describe about the Implementation of Recommendations on Hypertension for Health Study?

Hypertension which can also be referred as “high Blood pressure” in the arteries that can lead to damaged organs, renal failure, heart failure, heart attack, stroke and aneurysm. It is the most common and primary risk factor for a heart disease, renal disease or stroke. According to studies 1 in every 6 people worldwide is affected by “hypertension”. Though even now the actual causes of hypertension are unknown many factors are associated with this disease:-

Overweight or Obese
Smoking
Lack of activity (physical)
Diabetes
Sedentary lifestyle
Intake of high levels of salt
Thyroid problems or tumors or Adrenal problems
Aging
Stress
Vitamin D deficiency
Alcohol consumption in high levels
Insufficient magnesium, calcium, and potassium
Chronic Kidney problems
Consumption of birth control pills

According to the statistics the deaths related to cardio vascular diseases have decreased by 75 % in Canada. In this forty percent decreased in the last decade itself. But even today every seven minutes someone dies of stroke or heart disease in Canada. (RJ, 2002) Stroke and Heart disease are among the three leading causes of deaths in the country. This disease is not only costing lives but is also causing the economy a lot of money as according to the research done by Conference board of Canada in the year 2010, 21 billion dollars are spend on stroke and other heart diseases.

The Canadian Hypertension Education Program (CHEP) is a knowledge translation program that targets healthcare professionals in community and clinical settings. This program annually provides updated standardized recommendation along with guidelines for clinics to control, treat and detect hypertension. This program is responsible for the development of both electronic and printed dissemination and recommendations and evaluation. These evidence based recommendations, which are done annually, are developed through intense discussions on clinical implications. This program is funded and operated by Hypertension Canada. The members of these programs are volunteers who contribute their expertise and time to the annual dissemination and development of CHEP recommendations. (P. M. Kearney, 2005)The professional credibility of these recommendations and other content are maintained by ensuring that the process is free and independent from any external influence. The recommendations that are for the health professionals are translated and adapted into educational materials from providers and patients. These recommendations are published and are available for distribution to clinics, education centers, medical offices, hospitals, pharmacies and even by their free CHEP application for smart phones.

Through their efforts CANADA has become the leader in early detection of “Hypertension” or high blood pressure, its management and its treatment. Even after the early detection and numerous other achievements one in every three people have uncontrolled blood pressure and they are not even aware of this condition. (M. R. Joffres, 1997) The CHEP mission is to prevent and control blood pressure and various complications that are associated with it. Their vision is to ensure that Canadians have the best managed and healthiest blood pressure in the world. They aim to strive in four core areas:-

Knowledge generation through innovation and research

The Canadian Hypertension Education Program (CHEP)

Creative supportive environment through lifestyle policies and healthy public policies

Knowledge translation through moving discovery to practice

There are numerous sponsors and corporate partners for CHEP as Servier, Loblaw, Pfizer, Abbott, Medtronic and Merck  these companies not only contribute funds for the research and innovation but they also promote the hypertension education, control, research, and advocacy.

The major components in CHEP program is the research that they are doing in the field of hypertension currently, they have numerous initiated research programs. Some of them are the examination of efforts of the hypertension management. They examine the hypertension control rates along with the complication rates. (K. Wolf-Maier, 2003)They support the junior investigators for the investigation of hypertension and vascular biology. They have partnership with HSF (Heart and stroke foundation of Canada) and CIHR (Canadian Institutes of health Research) and other granting agencies that support postdoctoral and predoctoral trainees. Researches like “Perihematoma cerebral blood flow in unaffected by statin use in acute intracerebral hemorrhage patients”, “ Randomized assessment of rapid endovascular treatment of ischemic stroke”, “Framingham Ten-year general Cardiovascular Disease Risk: Agreement between BMI-based and Cholesterol-based estimates in a south Asian convenience sample”, “Refining Hypertension surveillance to account for potential misclassified cases”, “Systematic Review of Risk Adjustment Models of Hospital length of Stay (LOS), “Pulmonary hypertension due to fibrosing Mediastinitis treated successfully with stenting of pulmonary vein stenoses”. All of these researches were done in March, 2015 and these are only a few in the list of numerous researches that were conducted in March alone.

Their research is based on the surveys that give them the real picture about “Hypertension” prevalence in Canada. Lately they conducted a survey on the 18 + years and found out that thirty percent of them have uncontrolled blood pressure. (K. B. Zarnke, 2000)To monitor gaps like these they have added an Implementation task force that’s purpose is to acknowledge the existing gaps in management of hypertension and primary health care professionals to coordinate and integrate their efforts to decrease the rates of hypertension. 

AS CHEP is a volunteer based non-profit organisation it fits as“prevention” based program with the health care continuum, as the burden of Hypertension is being reduced through this optimized hypertension management. The entire process of screening, monitoring, treatment and diagnosing of hypertension generates a record family physician visits in any country. With these numbers we can find that the physicians are under a lot of work load and to make matters worse about 15% of the population of Canada does not have a family physician. As the studies have shown that the number of people getting affected by the disease is increasing constantly as the latest number show that one in every four people is affected by “Hypertension”.  In a study that was conducted on 50+ people showed that around 50.2 % of them were affected by this condition. (D. Drouin, 2006) These numbers are a far cry from the survey that was conducted between year 1986-1992 that showed that a minority of people were affected by the condition then and only needed treatment to control their blood pressure.

Research on Hypertension

The CHEP program is for providing guidelines to all age groups as one in 5 adult in Canada has hypertension or is at risk in developing the disease. Usually all adults require assessment of their blood pressure through-out life.  

For individuals that are at risk include the ones that experience high blood pressure as they are at risk within two years to develop “hypertension” by 40% in comparison to normal blood pressure level adults. According to the behavior change model the individuals that have an unhealthy diet, have low physical activity, consume tobacco, have dysglycemia, have abdominal obesity, take high sodium diet, and suffer from dyslipidemia are among the risk factors that can lead to “Hypertension”. If these risk factors are identified in time and successfully managed they can help in reducing cardiovascular events by 60%. These risk factors should be communicated by “vascular age”

To ensure that the CHEP is effective it is essential that the emphasis should be put on “Shared care” as health professionals should work in groups to prevent, detect, treat and help the patients to achieve lifestyle change and adhere to it. In a community, the diverse setting needs “coordination” in services on behalf of all health professionals as this will provide the most efficient care for the patients. It is crucial that the knowledge of physicians, nurses and pharmacists are integrated along with their skills. (N. R. C. Campbell, 2006) This overlapping of skills will provide optimal use of the resources of health care resources will allow various delivery options. As each health care professional is trained in a unique way, it contributes to patient care decisions. Here the concept “whole is greater than the sum of its parts” should be used. As the care and management of a patient is not only dependent on the blood pressure measurement but it involves many other factors that have to be taken care of. Each health care professional has a role of identifying, taking responsibility and communicating for patients and giving a collective plan to take care of them. CHEP should encourage and support shared responsibility for individuals with hypertension and who are at risk of hypertension. (K. Wilkins, 2010)

The target audience or the patients have to be involved in their care and their self management. To achieve it health care professionals require working with the patients. To ensure the success of patient care the treatment goal are aligned, reinforced and are clearly understood by both members who are patients and health care professionals both. Local groups such as exercise therapists, social workers and dieticians should be encouraged to develop the techniques to communicate. It is essential that the care should be provided to maximize the benefits of multidisciplinary, collaborative approach to hypertension management. These questions have to thought before drafting any plan:-

Are all the patients screened regularly?

Do the patients who are at high risk of hypertension (patients suffering from diabetes, and coronary heart disease) are routinely screened?

Do the routine lifestyle modifications decrease the risk of hypertension?

Gaps in Hypertension Management

Are the goals that have been set for the patient documented?

Are the patients informed about the blood pressure measurement?

Are the patients adhering to the lifestyle recommendations and medication?

Are these goals for treatment maintained over a long term?

Home BP monitoring is a tool for self management and self monitoring as it improves adherence. Healthy diet, reduction in sodium intake, regular physical activity, avoiding tobacco products, moderating alcohol prevention and managing the stress levels can help in preventing cardiovascular diseases and other risk factors that lead to hypertension.

Some of the gaps that are present in the policies of CHEP are that there is a prevalent individual influence and biasness in favor of achieving objective result. This objective result is needed for the evidence forming and for the up to date recommendations. (Sheldon, 2010)The data that is translated from scientific studies and trials into applicable and practical recommendations should be based on true numbers instead of being influenced by evidence formation. As the interdisciplinary health teams participate in these recommendations it should be revised yearly when new information is made available. Government bodies and academic bodies should oversee the CHEP program as costs have to be covered even when all the members are volunteers. A persistent and permanent financial support is needed for the continuity of such a program thus it is needed that academic and government body keep a check on the incurring costs. The collaboration between different health professionals could also lead to lack of clarity. If the professionals are not clear about their goals this could lead to hindrance in the success of the program. As CHEP is a multidisciplinary program it is essential to endorse an interdisciplinary collaboration to explore how it could be enhanced further. Currently not many studies have proven that the “collaborative care” that has been advised works well for the patient outcomes or not. But it is intuitive that we can prevent and control “hypertension” when skills and knowledge of all health care professionals are integrated and used collectively. We cannot rely only on the family physicians for our health as the disease management is changing and so is the scope of pharmacists, nurse practitioners, doctors and nurses. They have to be involved in a greater way in the management of chronic diseases. The increasing number of cases of “hypertension” also adds up to the need of collaborative care concept which is still in its “infant” stage and needs a lot of efforts and time. Through this essay we have learnt about CHEP and how we can collaboratively improve the care of people suffering from “hypertension” in our communities. Shared responsibility along with a common goal can help to make Canada “hypertension” free. The gaps that were discussed can be used by the researchers to encourage further research which will lead to improvement and success of this health program.

References:

Drouin, N. R. (2006). “Implementation of recommendations on hypertension: the Canadian Hypertension Education Program,”. Canadian Journal of Cardiology , 595–598.

B. Zarnke, N. R. (2000). “A novel process for updating recommendations for managing hypertension: rationale and methods,”. Canadian Journal of Cardiology , 1094–1102.

Wilkins, N. R. (2010). “Blood pressure in Canadian adults,”. Health Reports , 37–46.

Wolf-Maier, R. S. (2003). “Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States,”. Journal of the American Medical Association , 2363–2369.

R. Joffres, P. G. (1997). “Awareness, treatment, and control of hypertension in Canada,”. American Journal of Hypertension , 1097–1102.

R. C. Campbell, R. P. (2006). “Public education on hypertension: a new initiative to improve the prevention, treatment and control of hypertension in Canada,”. Canadian Journal of Cardiology , 599–603.

M. Kearney, M. W. (2005). “Global burden of hypertension: analysis of worldwide data,”. The Lancet , 217–223.

RJ, R. (2002). Building on values.The future of health care in Canada. SKCommission on the Future of Heath Care in Canada , 152-156.

Sheldon, N. R. (2010). “The canadian effort to prevent and control hypertension: can other countries adopt canadian strategies?”. Current Opinion in Cardiology , 366–372.

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