Reducing Hypertension Among Male Veterans Aged 25 to 60 Years in 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).
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).
Current data for male veterans being treated at the Michael E. DeLackey VA Medical Center are presented in Table 1 below.
Current aggregate patient data for the Michael E. DeLackey VA Medical Center, Houston
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.
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).
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
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 avoid the harmful effects of high blood pressure over time.
Note: Use the Minnesota Intervention Wheel as an aid in selecting the broad areas for nursing action.
To facilitate the return of blood pressure control to the 25% of the known MEDVAMC population that remains out of control.
Note: Select primary and secondary prevention activities only.
One public partnership that could facilitate the reduction in hypertension among Houston veterans is the Texas Cardiovascular Disease and Stroke Partnership (the "Partnership"). The Partnership consists of a network of healthcare providers from around the state that represent state and local public and private health care, university, non-profit, business and community sectors (Texas Cardiovascular Disease and Stroke Partnership, 2014). According to this entity, "The Partnership will work in coordination with the Texas Council on Cardiovascular Disease and Stroke to plan, implement and evaluate heart disease and stroke prevention programs and policies within the state" (Texas Cardiovascular Disease and Stroke Partnership, 2014, para. 2).
There are three overarching objectives associated with implementing the foregoing activities:
Raise awareness among veterans concerning the dangers of hypertension.
Identify and encourage affected veterans to seek healthcare assistance at the MEDVAMC and its hypertension programming.
Conduct follow-up reviews to ensure recently enrolled hypertensive veteran patients remain in treatment.
A tentative timely for expected outcomes in set forth in Table 2 below.
Tentative timely for expected outcomes
TIME (MONTHS) (2014-2105)
Public awareness campaign ongoing
Identity untreated hypertensive veterans
Conduct follow-up reviews
1. Explain how you would evaluate whether the efforts to improve the health concern were effective.
The initiative envisioned herein would be evaluated for effectiveness using the baseline data for veterans in 2005 and 2010 to determine if progress is being made and to identify opportunities for fine-tuning the program offerings.
2• Include in your explanation the tools you might use to do this evaluation.
The MEDVAMC decentralized hospital computer program will be used to made comparison with the historic baseline data for hypertension.
1. Reflect on how your perspective of the community's health and the national, state, and local efforts toward a healthier population has changed as a result of your fieldwork.
Hypertension can be a silent killer because the symptoms of the disease can be deceptive and misleading, causing some individuals to forego medical care which allows the condition to worsen in the extreme. Timely diagnosed and treated, though, people with hypertension can get their blood pressure back under control and live normal, productive lives. To the uninformed, analysis, hypertension may not appear to be a major public health concern but the research clearly indicates that high blood pressure can result in a number of adverse health conditions, including death.
About DVAMC. (2014). Michael E. DeBakey VA Medical Center - Houston, Texas. Retrieved from http://www.houston.va.gov/about/index.asp.
Findley, P. & Shen, C. (2011, May). Multimorbidity and persistent depression among veterans with diabetes, heart disease, and hypertension. Health…
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