Effectiveness of nursing case management versus usual care for blood pressure control in adults with hypertension: a systematic review

Objective. To synthesize the best available evidence regarding the effectiveness of nursing case management in primary health care, compared to usual care, in improving blood pressure in adults over 18 years with hypertension. Methods. systematic review that includes studies carried out with adult patients diagnosed with hypertension, with or without other concomitant chronic diseases, followed-up by a case manager nurse, who evaluated the effectiveness of case management in the improvement of blood pressure. A critical evaluation of the studies was made and the results of interest were described using the instruments and tools from the Joanna Briggs Institute. Due to the heterogeneity of the included studies, the results of similar measures were not grouped in statistical meta-analysis. A narrative and tabular format was used to synthesize and present them. Results. Six randomized controlled trials were critically evaluated and included in the review. The total sample was 1963 participants. The results showed the outcomes compared at baseline and at the end of follow-up (six or twelve months). Regarding the main outcome, systolic and diastolic blood pressure, there was some reduction in the group followed-up through case management in studies lasting six months; however, the impossibility of comparing the findings poses limitations to answering the questions in this review. Conclusions. Despite the heterogeneity of the studies, the narrative and tabular analysis demonstrated that short-term case management in primary care (six-month studies) helped to reduce blood pressure levels, although the level of evidence for these results is low or very low.

Objetivo. Sintetizar las mejores evidencias disponibles sobre la efectividad del manejo de casos de enfermería en la atención primaria en salud en comparación con los cuidados habituales para mejorar la presión arterial en adultos mayores de 18 años con hipertensión arterial sistémica. Métodos. Revisión sistemática de estudios realizados en pacientes adultos con diagnóstico de hipertensión arterial, monitoreados por el enfermero gestor de casos quien evaluó la efectividad del manejo de la mejoría de la presión arterial con o sin otras enfermedades crónicas concomitantes. Se realizó una evaluación crítica de los estudios y se describieron los resultados de interés utilizando los instrumentos y herramientas del Instituto Joanna Briggs. Debido a la heterogeneidad de los estudios, los resultados de medidas similares no se agruparon en el meta-análisis estadístico. Se utilizó un formato narrativo y tabular para sintetizarlos y presentarlos. Resultados. Seis ensayos clínicos aleatorios fueron evaluados críticamente e incluidos en la revisión. La muestra total fue de 1963 participantes. Los resultados mostraron los hallazgos comparados al inicio y al final del seguimiento (seis o doce meses). En cuanto al resultado principal, la presión arterial sistólica y diastólica tuvo una reducción en el grupo acompañado por el gestor de manejo de casos en los estudios que duraron seis meses; sin embargo, la imposibilidad de comparar los hallazgos plantea limitaciones para responder las preguntas de esta revisión. Conclusión. A pesar de la heterogeneidad de los estudios, el análisis narrativo y de las tablas demostró que la gestión de casos por enfermería, a corto plazo (estudios de seis meses), en atención primaria, ayudó a reducir los niveles de presión arterial, aunque el nivel de evidencia para estos resultados fue bajo o muy bajo.

Objetivo. Sintetizar as melhores evidências disponíveis sobre a efetividade do gerenciamento de casos de enfermagem na atenção primária em saúde, em comparação com os cuidados usuais na melhoria da pressão arterial em adultos acima de 18 anos com hipertensão arterial sistêmica. Métodos. Revisão sistemática que incluiu estudos realizados com pacientes adultos diagnosticados com hipertensão, com ou sem outras doenças crônicas concomitantes, acompanhados por enfermeiro gestor de casos, que avaliou a eficácia do gerenciamento de casos na melhora da pressão arterial. Foi realizada uma avaliação crítica dos estudos e descritos os resultados de interesse com a utilização dos instrumentos e ferramentas do Instituto Joanna Briggs. Devido à heterogeneidade dos estudos incluídos, os resultados de medidas semelhantes não foram agrupados na meta-análise estatística. Um formato narrativo e tabular foi usado para sintetizá-los e apresentá-los. Resultados. Seis ensaios clínicos randomizados foram avaliados criticamente e incluídos na revisão. A amostra total foi de 1963 participantes. Os resultados mostraram os desfechos comparados no início e no final do acompanhamento (seis ou doze meses). Em relação ao desfecho principal, pressão arterial sistólica e diastólica, houve alguma redução no grupo acompanhado pelo gerenciamento de casos em estudos com duração de seis meses; no entanto, a impossibilidade de comparar os achados impõe limitações para responder às perguntas desta revisão. Conclusões. Apesar da heterogeneidade dos estudos, a análise narrativa e tabular demonstrou que o gerenciamento de casos de curto prazo na atenção primária (estudos de seis meses) ajudou a reduzir os níveis de pressão arterial, embora o nível de evidência para esses resultados seja baixo ou muito baixo.

Nursing case management for people with hypertension in primary health care: A randomized controlled trial.

INTRODUCTION: Hypertension is a chronic disease that requires continuous and long-term care to prevent or delay the development of associated complications. Although various interventions for hypertension exist, case management in Brazil's primary healthcare is understudied. We examined nursing case management effectiveness for controlling blood pressure among Brazilian adults with hypertension in the public healthcare system. METHOD: A randomized controlled trial with a 12-month follow-up was conducted at a primary healthcare clinic in southern Brazil. Adult patients with hypertension were randomly allocated to intervention (n = 47) and usual care groups (n = 47). The nursing case management model includes nursing consultations, telephone contact, home visits, health education, and appropriate referrals. Patient outcomes (blood pressure, body mass index, waist circumference, quality of life, treatment adherence) were assessed at baseline and 6- and 12-month follow-up for the intervention group and at baseline and 12-month follow-up for the usual care group. Data were collected from only the intervention group at T6 to avoid contact between the researcher and the usual care group, and to check the care plan and modify it if necessary. RESULTS: After the intervention, the intervention group's blood pressure decreased significantly compared to the usual care group. The differences in systolic and diastolic blood pressure between the groups was -8.3 (intervention)/1.1 (usual care) mmHg (p = .004) and -7.4/-0.6 mmHg (p = .007), respectively. The intervention group had significantly greater improvement in waist circumference (-2.0/1.2 cm), body mass index (- 0.4/0.3), and treatment adherence (4.8/-1.1) than the usual care group (all p < .05). CONCLUSION: Nursing case management in primary healthcare may be effective for improving outcomes among patients with hypertension.