Treating Hypertension Among a Population of Combat Veterans Essay

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Reducing Hypertension Among Male Veterans Aged 25 to 60 Years in Houston Texas

Describe the community where you performed your fieldwork. In your description, identify each of the following items:

• Geographical area (e.g., county, city, town): Houston, Texas

• Area size: The fourth most populous city in the country (after New York, Los Angeles and Chicago), Houston is the fourth most populous city in the nation and the largest city in the southern U.S. And Texas (Houston facts and figures, 2014). The Houston-Galveston-Brazoria Consolidated Metropolitan Statistical Area (Houston CMSA) is comprised of eight separate counties: Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller (Houston facts and figures, 2014). The Houston CMSA includes 8,778 square miles, an area larger than New Jersey (Houston facts and figures, 2014).

• Population size: As of 2010, the City of Houston had a population of 2.1 million; as of 2010; the metro area's population of 5.95 million was the 6th largest among U.S. metropolitan statistical areas and represented a 26% increase since 2000 (Houston facts and figures, 2014).

• Demographics: The demographics for Houston show that the city has the youngest population in the United States as well as the third-largest Hispanic and Mexican populations in the country (Houston facts and figures, 2014)

• Physical and social environment: Houston is 43 feet above sea level, and is located at 29 degrees 45 minutes north latitude and 95 degrees 22 minutes west longitude (Houston facts and figures, 2014). The cost of living in Houston is 9% below the national average, and housing costs are 29% lower than the national average (Houston facts and figures, 2014). The city is also well represented in professional sports leagues (Houston facts and figures, 2014).

2. Create a community genogram/profile reflecting the health status of the community.

Note: This should be included as an appendix.

3. Discuss the health concern you studied in your fieldwork. Include the following:

• Background in relation to Healthy People 2020 (2010) and local public health data that characterizes this health concern

A Healthy People 2020 objective is to improve health-related quality of life and well-being for all individuals. According to Health People 2020, "Health-related quality of life (HRQOL) is a multi-dimensional concept that includes domains related to physical, mental, emotional, and social functioning" (Healthy People 2020 objectives, 2014, para. 2). This objective focuses on individual quality of life factors that relate to a sense of well-being and healthy condition (Healthy People 2020 objectives, 2014), making the reduction of hypertension a highly congruent initiative. In this regard, Healthy People 2020 emphasize that, "Well-being is a relative state where one maximizes his or her physical, mental, and social functioning in the context of supportive environments to live a full, satisfying, and productive life" (Healthy People 2020 objectives, 2014, para. 4).

The citizens of Houston also enjoy world-class healthcare services. In fact, Houston is home to the Texas Medical Center, the largest medical center in the world with 42 nonprofit and government institutions (these figures include 13 teaching hospitals, two medical schools, four colleges of nursing, a dental college, a college of pharmacy and a college of optometry) with nearly 5 million patients treated annually (Houston health, 2014).

Veteran citizens of Texas who are eligible by virtue of the quality of their service (no dishonorable discharges) can also obtain healthcare from the Michael E. DeBakey VA Medical Center. Currently, the MEDVAMC provides primary healthcare services to nearly 130,000 veterans in the southeast Texas region (About MEDVAMC, 2014). According to the MEDVAMC, "Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases" (About MEDVAMC, 2014, para. 2). The MEDVAMC includes a number of outpatient resources, including:

A Post-Traumatic Stress Disorder Clinic;

Network Polytrauma Center;

An award-winning Cardiac and General Surgery Program;

Liver Transplant Center;

VA Epilepsy and Cancer Centers of Excellence;

VA Substance Abuse Disorder Quality Enhancement Research Initiative;

Health Services Research & Development Center of Innovation;

VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury;

A Kidney Transplant Center;

Mental Illness Research, Education and Clinical Center; and,

One of the VA's six Parkinson's Disease Research, Education, and Clinical Centers (About MEDVAMC, 2014, para. 3).

The MEDVAMC also operates a network of satellite outpatient clinics in Beaumont, Conroe, Galveston, Houston, Katy, Lufkin, Richmond, Tomball and Texas City which treat more than 1 million veterans each year (About MEDVAMC, 2014).

• Data from national, state, and/or local level related to the health concern

At present, approximately one-third (about 67 million) American adults suffer from hypertension or high blood pressure (High blood pressure facts, 2014). In addition, less than one-half (47%) of all hypertensive sufferers have their disease under control (High blood pressure facts, 2014). Another one-third of all American adults suffer from prehypertension, a condition that is characterized by higher blood pressure levels than normal but which remain outside of the hypertension pressure range (High blood pressure facts, 2014). The economic costs of hypertension are staggering, with nearly $48 billion being spent every year on the condition, a cost that includes medications to treat high blood pressure, the costs of health care services and absenteeism from work (High blood pressure facts, 2014).

4. Describe the population of interest affected by the health concern you studied in your fieldwork. In your description, include each of the following components:

• Gender: Male

• Age:

Aged 25 to 60 years

• Demographics including socioeconomic status and educational level: Veterans with any socioeconomic status and education level are of interest to this study.

a. Explain how this health concern is linked to a health inequity for the population of interest. Although there remains a paucity of timely and relevant research in this area, veterans in general and believed to be at higher risk of hypertension compared to their non-veteran counterparts (Findley & Shen, 2011).

b. Use data to support your conclusion.

Current data for male veterans being treated at the Michael E. DeLackey VA Medical Center are presented in Table 1 below.

Table 1

Current aggregate patient data for the Michael E. DeLackey VA Medical Center, Houston








Highly Rural















VA Region










The data depicted in Table 1 above indicate that almost two-thirds (62%) of the veterans in the DVAMC living in urban areas while 36% of the veterans live in rural regions of the state. This data also indicates that 11% of the veterans served by the Department of Veterans Affairs (VA) in Houston were on active duty during Operation Enduring Freedom or Operation Iraqi Freedom, meaning they are among the youngest veterans receiving VA benefits and services. The other health indicators listed show that Houston's health indicators are basically on par with the rest of the state.

5. Discuss the community resources and partners (e.g., mission, activities, and websites) currently involved with the health concern.

Gulf War veterans from the United States have consistently reported suffering from a broad array of healthcare issues and symptoms; however, the rates of hypertension for veterans are comparable for those that were deployed into combat zones and those that received hazard-free assignments (Schneider, 2009). In response to the need for hypertension interventions for Houston veterans, the MEDVAMC implemented a quality-improvement initiative in September 2006 targeted at helping veterans get their blood pressure under control (VA has solution for high blood pressure, 2010). The hypertension initiative employs intensive appointment scheduling within a brief period, group clinics, as well as standardized measurement techniques to concentrate VA resources on helping veterans lower their blood pressure levels (VA has solution for high blood pressure, 2010). As a result of this initiative, more than three-quarters (75%) of veteran patients at the MEDVAMC have succeeded in getting their hypertension under control compared to just over half (54%) in 2005 (VA has solution for high blood pressure, 2010).

B. Diagnosis

1. Discuss aspects of the health concern not being addressed despite the efforts of the partners involved.

The diagnosis of hypertension is a straightforward process that involves using a series of blood pressure tests; individuals that test 140/90 mmHg or higher over time are regarded as having hypertension (How is high blood pressure diagnosed, 2014). According to McLendon and Shelton (2011), though, "Most symptoms can derive from any number of causes and frequently involve multiple factors. Vague complaints such as weakness, fatigue, or decreased appetite often are often the only physical symptoms that patients describe-symptoms that may suggest an underlying problem" (p. 26).

C. Outcomes Identification

1. Explain the ultimate outcome(s) or goal(s) for improvement related to the health concern.

Because there is no cure for hypertension, the ultimate goal for improvement related to this health concern is the ability of veterans to get their blood pressure back under control to…[continue]

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