Adolescent Hypertension at a School-Based Health Center: A Pre-Implementation Study Using the Tailored Implementation for Chronic Diseases (TICD) Checklist

Problem: Adolescent hypertension is a significant concern in the primary care setting. Adolescents are generally healthy but may go undiagnosed with high blood pressure, which can lead to increased risk for developing cardiovascular conditions in adulthood. The updated guidelines released by the American Academy of Pediatrics in 2017 reclassify adolescents to tighter blood pressure categories. The purpose of this project is to evaluate current practices meeting the updated American Academy of Pediatrics (AAP) guidelines for management of adolescent hypertension in the context of a school-based health center (SBHC). In this school-based clinic, there is a need for ongoing process improvement to assess, manage, and treat high blood pressure in the adolescent student population based on the updated guidelines.Project Aim: The primary aim of this quality improvement (QI) project was to utilize a comprehensive, integrated checklist of determinants (facilitators and barriers) of practice, based on the Tailored Implementation for Chronic Diseases (TICD) framework. This tool evaluated the evidence-based practices for managing adolescent hypertension at the school-based clinic. The secondary aim was to develop recommendations for overcoming barriers to guideline implementation and present to the clinic board.Project Method: REDCap survey invitations were sent to seven Family Medicine faculty members that assist in the management of the SBHC. REDCap surveys aimed to assess determinants including guideline recommendations, individual health professional factors, patient factors, professional interactions, capacity for organizational change, and social and political factors using the TICD checklist . The surveys were anonymous, and no unique identifiers of the participants collected. Factors that prevent or enable implementation of the updated blood pressure guidelines were identified. Recommendations were provided to the clinic board for implementation of the guidelines in terms of the process of blood pressure measurement, diagnosis, and management of hypertension in student patients in the school-based clinic.Results: Of the seven faculty who were invited to participate, six completed the survey resulting in a participation rate of 85.7%. The most frequently cited theme that emerged from survey data included knowledge gaps for medical student providers and a lack of resources to improve guideline adherence and implementation.Conclusion: Based on the feedback received from the survey data, an area of focus for improved guideline adherence includes increasing the knowledge gaps that exist with medical student providers as well as the creation of a clinical decision support tool to improve adherence. Overall, the findings from this Doctor of Nursing Practice project provided useful information for the board of directors of the SBHC. Future projects should be implemented to increase the knowledge gaps of an increasing health problem among a vulnerable population.

Grantor dc:publisher

University of Kansas

Year dc:date.issued

2022

Author dc:creator

• Gasperlin, Spela

Advisor dc:contributor.advisor

• Bosak, Kelly A

• Nursing

Statement dc:rights

• Copyright held by the author.

Language dc:language.iso

en

Dc Identifier Other

http://dissertations.umi.com/ku:18136

OAI identifier oai:identifier

oai:kuscholarworks.ku.edu:1808/36622