The ImPress study: Impact of a nurse-delivered intervention to identify primary care patients with hypertension and provide care directed at improving blood pressure

Pre intervention education for participating General Practice nurses (GPNs) will be provided prior to implementation. This will comprise of an all day workshop covering hypertension etiology, blood pressure management strategies, motivational interviewing techniques and Clinical Auditing Tool application. The research team facilitating the workshops have extensive skills and expertise in primary health care across clinical, academic and educational domains. Following the assessment visit and study enrollment, patients will attend three face to face GPN appointments and two telephone consultations throughout intervention. All consultations will be underpinned by a person centred approach with the GPN utilising motivational interviewing techniques and the 5 As’ to build rapport, set goals and offer support for self-management. The 5 A's framework enables the GPN to structure visits through the following steps- Asses, Advise, Agree, Assist and Arrange. The 3 face to face appointments will be conducted over a 6 month period, 1 hour in duration arranged at a mutually convenient time for the GPN and patient. The GPN will provide 2 telephone calls no longer than 15 minutes in duration over the 6 month intervention period at a time convenient to the patient. While the aim of first GPN consultation is to record baseline BP, biometric measures and lifestyle risks, this initial encounter is an opportunity to build rapport and shared understanding. Subsequent visits will focus on individualised action planning in partnership with the patient, goal setting and feedback on progress. GPs contribution will involve medication optimisation in line with Australian hypertension guidelines (National Heart Foundation of Australia, 2016, Guideline for the diagnosis and management of hypertention in adults) Templates to structure each nursing assessment will be uploaded to the practices computerised clinical files in Director or Best Practice .To streamline the data entry process, templates will have the capacity to pre-populate existing patient details. GPNs will be encouraged to collaborate with the participating General Practitioners (GP) to share information around the nursing care being provided. Patients participating in the intervention will keep a copy of their action plan which will be annotated at each visit. This will record their progress to date and ongoing goals.