HEP 456 Module 1 Assignment Section 3,4 and 5 Evaluation Plan Draft

HEP 456: Health Promotion Program Eval

Arizona State University

Dean Helitzer

20th October 2022

Background Literature on Program Need

Dialysis patients have much higher rates of hypertension than the general population. As is for the general population, hypertension is one of the major causes of cardiovascular mortality in dialysis patients. Since there have been so few high-quality clinical trials conducted, there are still numerous unanswered questions and concerns about managing hypertension, making it difficult to treat hypertension in dialysis patients.

Hypertension in hemodialysis patients is diagnosed when blood pressure is more than 140/90 mmHg before dialysis or greater than 130/80 mmHg after dialysis, as outlined by the Kidney Disease Outcomes Quality Initiative recommendations published in 2004 by the National Kidney Foundation (Sarafidis et al., 2019). Seventy percent or more of dialysis patients have high blood pressure, and only around 20% of those with high blood pressure have it well controlled (BP). Hypertension is also common among those undergoing peritoneal dialysis (PD), with estimates ranging from 30 to 90 percent. The wide range of hypertension diagnostic methods and terminologies is primarily to blame. Epidemiological studies conducted in Gulfport, Mississippi, indicated that 72%-88% of the people examined had high blood pressure (BP), depending on the definition of hypertension (Ashby et al., 2019). Antihypertensive medicine was more commonly used by patients with high blood pressure, however only 30–50% of patients in those trials had their blood pressure under control. Dialysis patients with renal failure nearly always take medication to reduce their blood pressure. Many of these people have hypertension due to an excess of fluid in their bodies; however, regular dialysis can help eliminate some of this fluid. Nevertheless, medication for excessive blood pressure is still required for about 60% of hemodialysis patients and 30% of peritoneal dialysis (PD) patients. Studies have linked both low blood pressure and high blood pressure, such as the U-shape, to an increased risk of death in dialysis patients, although arrhythmia and cardiac arrest account for around 25% of deaths in the United States.

In most cases, hemodialysis patients will have three sessions each week. The patient’s weight and amount of excess fluid often increase just before dialysis and decrease after it. Naturally, the systolic blood pressure is highest just before hemodialysis, and the diastolic pressure is lowest just after (Heerspink et al., 2009). It’s usual for patients to experience low blood pressure after undergoing hemodialysis. Constipation, dizziness, fainting, nausea, and vomiting are some of the negative symptoms. Keeping fluid consumption under control is essential for maintaining normal blood pressure. This program will focus on the needs of people aged 25–40 who are undergoing dialysis. This is because these individuals are most likely not to follow the laid down procedures for managing hypertension. In addition, dialysis patients often have excessive blood pressure due to obesity. Adults are urged to be mindful of their foods, limit their sodium intake, and choose healthful options.

The intended outcome of the new program is to enhance the quality of life for those who will be participating in it. Dietitians will monitor the patients' diets and fluid intake as part of the advantages they receive. To complement this, patients will participate in activities designed to maintain healthy blood pressure and heart rates. The hospital will also offer transportation services to help patients get to and from the facility. The initiative will be a huge success and a forerunner to similar programs.

Several programs have been designed so far to help dialysis patients with hypertension. The Chronic Kidney Disease (CKD) Initiative was launched by the CDC in 2006 to promote public health measures for enhancing kidney health (Bragg-Gresham et al., 2019). Several US dialysis patient hypertension initiatives have benefited from this task force’s efforts. The CKD Initiative works with the Making Dialysis Safer Coalition Program to fund hypertension management options for hemodialysis patients.

Introduction to the Program

The priority population for this program will be newly diagnosed dialysis patients at Memorial Hospital Gulfport. As aforementioned, the target population for this program will be patients suffering from high blood pressure aged between 25 and 30. Patients in this age bracket take many things for granted and do not follow the correct procedure for dialysis to avoid having high blood pressure issues. New patients diagnosed with ESRD at Memorial hospital will be given top priority. The gender of the patients will not determine the eligibility of the patients, but we expect that more women will be enrolled in the program since they comprise of a bigger percentage of the hemodialysis population in Mississippi. The program will have a total of 150 participants i.e., dialysis patients. In addition, the program will also encompass a total of 15 staff members i.e., a charge nurse, 3 floor nurses, a patient advocate, 3 social workers, a dietician, 5 therapists, and a CHES. The program will consist of dialysis activities, physical activities, therapy sessions, and education and interaction sessions. Dialysis will take place on the left-wing of the Gulfport Memorial hospital, the physical activities will take place on the rooftop, the therapy sessions will take place next to the psychiatric facilities, and the interactions and education will take place in the nurse’s cafeteria.

The main goal of this project is to prevent complications for patients on dialysis and promote long-term healthy habits for patients who have been admitted to Gulfport Memorial Hospital. The program is expected to improve the health of its participants, reduce the risk of one having complications during dialysis, equip its participants with additional knowledge on how to be on dialysis and still be healthy, and educate its participants on the need for one to take care of their bodies and eating habits.

Logic Model of the Program

References

Ashby, D., Borman, N., Burton, J., Corbett, R., Davenport, A., Farrington, K., Flowers, K., Fotheringham, J., Andrea Fox, R. N., Franklin, G., Gardiner, C., Martin Gerrish, R. N., Greenwood, S., Hothi, D., Khares, A., Koufaki, P., Levy, J., Lindley, E., MacDonald, J., … Wilkie, M. (2019). Renal Association Clinical Practice Guideline on Haemodialysis. In BMC Nephrology (Vol. 20, Issue 1). https://doi.org/10.1186/s12882-019-1527-3

Bragg-Gresham, J., Morgenstern, H., McClellan, W., Saydah, S., Pavkov, M., Williams, D., … & Centers for Disease Control and Prevention CKD Surveillance System. (2018). County-level air quality and the prevalence of diagnosed chronic kidney disease in the US Medicare population. PloS one, 13(7), e0200612.

Heerspink, H. J. L., Ninomiya, T., Zoungas, S., de Zeeuw, D., Grobbee, D. E., Jardine, M. J., Gallagher, M., Roberts, M. A., Cass, A., Neal, B., & Perkovic, V. (2009). Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. The Lancet, 373(9668). https://doi.org/10.1016/S0140-6736(09)60212-9

Sarafidis, P. A., Mallamaci, F., Loutradis, C., Ekart, R., Torino, C., Karpetas, A., … & Zoccali, C. (2019). Prevalence and control of hypertension by 48-h ambulatory blood pressure monitoring in haemodialysis patients: a study by the European Cardiovascular and Renal Medicine (EURECA-m) working group of the ERA-EDTA. Nephrology Dialysis Transplantation, 34(9), 1542-1548.