P.TAY1, X.H.KOH1, Y.R.CHUA1, J.YAP1, S.F.LIM2, Y.XU2, X.L.CHUA3, S.Y.K.LIM3, H.C.OH3, S.S.H.TEO3, P.C.TAN1
Changi General Hospital1, Singapore General Hospital2, SingHealth HQ3
SingHealth Community Nurse Posts (CNPs) were established to enhance secondary and tertiary health prevention in Singapore. This study aims to investigate the effect it has on Blood Pressure (BP), and the extent to which diabetes mellitus (DM) influences that effect.
A single-group pre-post study was conducted amongst older adults at SingHealth CNPs between 01 April 2019 and 31 March 2020. Study participants had no prior CNP visit with suboptimal hypertension control. BP measurements within three months from the first visit were compared to those on the first visit using linear generalized estimating equations, adjusted for baseline age, gender, and race. Effect modification by suboptimal DM control was assessed on the additive scale. Sensitivity to assumptions of missingness was assessed using multiply imputed datasets.
Data of 595 older adults (median age 72 years) at 51 CNPs were analysed. Linear generalized estimating equations model showed a population-average reduction of 5.48mmHg (95% confidence interval -6.99 to -3.96, P<0.001) in systolic and 2.16mmHg (-3.11 to -1.21, P<0.001) in diastolic BP. There was a 47% (0.44 to 0.64, P<0.001) reduction in odds of having suboptimal BP. Older adults without DM had a 3.92mmHg (0.88 to 6.95, P=0.011) and a 2.24mmHg (0.37 to 4.11, P=0.019) greater reduction in Systolic and Diastolic BP respectively. Sensitivity analyses showed consistent results.
SingHealth CNPs may be associated with improvements in BP, resulting in cardio-protective benefits especially for those with DM. CNPs show potential to benefit chronic disease management amongst older adults, enhancing quality of life with comorbidities.