Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study.

BACKGROUND: African Americans have a higher prevalence and greater severity of hypertension than do other minorities and whites. This fact is particularly problematic when one realizes that the rate of control and treatment of hypertension in the US population is getting worse rather than better. Alternative strategies to promote blood pressure control need to be tested. OBJECTIVES: The purpose of this pilot study was to test the following hypothesis: Persons who participate in nurse-managed home telemonitoring (HT) plus usual care or who participate in nurse-managed community-based monitoring (CBM) plus usual care will have greater improvement in blood pressure from baseline to 3 months' follow-up than will persons who receive usual care only. METHODS: This study used a randomized controlled design; participants were randomly assigned to 1 of 3 groups that were stratified by use or nonuse of antihypertension medication. One-way analysis of variance (ANOVA) and analysis of covariance (ANCOVA) controlling for age and body weight were used to determine changes in blood pressure from baseline to 3 months. The sample contained 26 African Americans with a mean age of 59 years. RESULTS: Both the HT group and the CBM group had clinically and statistically significant (P <.05) drops in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3 months' follow-up, with participants in the HT group demonstrating the greatest improvement (HT: baseline SBP 148.8 +/- 13.8, DBP 90.2 +/- 5.79; 3 months' follow-up SBP 124.1 +/- 13.82, DBP 75.58 +/- 11.4; CBM: baseline SBP 155.25 +/- 17.014, DBP 89.42 +/- 10.95; 3 months' follow-up SBP 142.3 +/- 12.1, DBP 78.25 +/- 6.86). There was little change in SBP or DBP at 3 months' follow-up in the usual care only group. CONCLUSION: These are important pilot results, which if replicated in a larger sample will significantly improve care for urban African Americans with hypertension.

Wound prevalence, types, and treatments in home care.

OBJECTIVE: To ascertain the number of home care patients with wounds, determine the types of wounds being treated in the community, and identify wound care treatments used at home. DESIGN: Descriptive, multisite, collaborative project. SETTING: 13 home care agencies located throughout lower Michigan that had voluntarily formed a research consortium. The location of patients visited was 43% urban, 39% suburban, 16% rural, and 2% unaccounted. PATIENTS: Systematic sampling was used to select nurses in each agency to collect data. Nurses (n = 281) recorded information about adult patients visited during the 1 week of the study. Data were recorded about 2847 patients, M age = 72.5 years. They included 1793 women and 1040 men (gender was not recorded for 14 patients); most patients in the sample (72%) were white. MAIN PLANNED OUTCOMES: A significant number of home visits would include wound care and that wound care would be primarily done with tap water and gauze. RESULTS: Wounds were present in 36.3% of patients. Of the patients with wounds, 58.3% had 1 wound and 41.7% had multiple wounds. Wound types included surgical (62.4%), pressure ulcers (24.9%), and vascular leg ulcers (22.2%). Tap water and gauze were the most-used wound care treatments. Patients with wounds had significantly longer home care visits than patients without wounds. CONCLUSIONS: Patients with wounds are commonly found in home care. There is a low utilization of specialty dressings and commercial irrigation solutions across all wound types. Nurses who follow patients with wounds may need additional time to provide the care.

Social support, demands of illness, and depression in chronically ill urban women.

In this study we used structural equation analysis to examine the relationship between chronic illness and depression among urban women. The model included the number of chronic illnesses reported, the demands of illness, perceived social support, and salient demographic variables as predictors of depression. The number of chronic illnesses had no direct effect on depression but had a direct impact on the demands of illness which led to decreased social support and increased depression. Being married played a protective role by reducing depression both directly and indirectly through increased social support. Having children under 18 in the home increased depression by increasing the demands of illness. These results provide important information about women with chronic illness and their resultant risk of depression.