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Implementing a Nurse-Driven Protocol for Hypertension Management in Primary Care
Barclay, Shandi Aitken, Margaret Eckhaus, Jeremiah
Barclay, Shandi
Aitken, Margaret
Eckhaus, Jeremiah
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Abstract
Hypertension remains a leading cause of cardiovascular morbidity, with up to 40% of treated patients uncontrolled. At a rural Vermont primary care clinic, rates mirrored national trends, highlighting the need for innovative care models. Evidence supports nurse-led chronic disease management to improve blood pressure control and access. This quality improvement project implemented a nurse-driven hypertension management protocol to improve blood pressure, enhance self-management, increase care frequency, and assess feasibility. This 16-week project, guided by the Chronic Care Model, enrolled adult patients with uncontrolled hypertension referred by primary care providers using a standardized order set. Registered nurses provided education on lifestyle modification and home blood pressure monitoring, with follow-up every two weeks. Medications were titrated using a provider-approved algorithm. Outcomes included blood pressure change, time to goal, nurse visits, goal attainment, access metrics, and patient and staff perceptions. Forty patients were enrolled. Mean systolic blood pressure decreased from 150.1 to 128.4 mmHg and diastolic from 89.2 to 77.6 mmHg (p < .001). Patients reached goal in a mean of 34.9 days with 3.1 nurse visits; 65% achieved control, 15% improved but remained slightly above goal, and 20% were lost to follow-up. Same-day nurse access contrasted with a 19-day provider wait. The protocol was feasible, well-accepted, and improved outcomes and access, supporting scalability for broader hypertension control.
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2026-05-05
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BarclayS_04022026_FINAL MANUSCRIPT.pdf
Adobe PDF, 1.82 MB
- Embargoed until 2027-05-02