Impact of primary care nursing workforce characteristics on the control of high-blood pressure: A multilevel analysis
Entidad
UAM. Departamento de Cirugía; UAM. Departamento de Medicina Preventiva y Salud Pública y MicrobiologíaEditor
BMJ Publishing GroupFecha de edición
2015-01-01Cita
10.136/bmjopen-2015-009126
BMJ Open 5.1 (2015): e009126
ISSN
2044-6055DOI
10.136/bmjopen-2015-009126Financiado por
The results presented here form part of a study that has been funded partially with the First Prize for National Research in Nursing (12th edition) from Hospital Universitario Marqués de Valdecilla (Santander) in 2010.Versión del editor
http://dx.doi.org/10.1136/bmjopen-2015-009126Materias
Primary Health Care; High-blood pressure; MedicinaResumen
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 selfperceived
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
Lista de ficheros
Google Scholar:Parro Moreno, Ana Isabel
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Serrano Gallardo, María del Pilar
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Díaz-Holgado, Antonio
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Aréjula-Torres, José L.
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Abraira, Víctor
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Santiago-Pérez, Isolina M.
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