Introduction
Cardiovascular disease is a common disease that makes it impossible for the cardiovascular system to provide the body with enough nutrients and oxygen during sustained physical activities. The major causes of cardiovascular disease are narrow blood vessels which can not deliver enough blood to the muscles or a weak heart which can not pump enough blood to the muscles. A weak heart is as a result of poor signaling or infections affecting the heart muscles. Healthy blood vessels are strong and flexible. They can with stand the high pressure of blood pumped from the heart. When cholesterol is deposited along the inner walls of blood vessels, they become narrow and the blood pressure increases. In addition, the blood vessels loose flexibility and become stiff. They can easily rupture under pressure. Cardiovascular disease is a huge burden to the health sector and better management strategies are required.1 Cardiovascular risk factors are well known and can be avoided to minimize the risk of contracting the disease.
In this project a pharmacist led educational program is implemented to teach patients and high risk groups about the causes of the cardiovascular disease and how to protect themselves. Pharmacist are suited to educate patients because of the critical role they play in health care delivery and the interactions the have with patients.2 The adopted teaching method is giving patients leaflets and verbal expiations on the risk factors of the cardiovascular disease and how to avoid these risk factors. The study used pre and post teaching tests to evaluate the teaching method used. The results reflect a significance change in participants’ behavior such as dieting, exercising regularly and quitting smoking after the teaching which identified these as major risk factors of the cardiovascular disease.
Importance of Patient Education
Quality health care must be patient-centric where the patient is treated as a partner not as a victim in health care delivery. Patient education is one of the ways of incorporating patients into the health care delivery system. Patient education on cardiovascular diseases focuses on the risk factors of the disease. Imparting patients with knowledge of cardiovascular disease risk factors is aimed at altering the patient’s health behaviors to improve health status and minimize future risks. Studies show that patient education is an important factor in promoting patient well being and influencing health outcomes.3
Pharmacists as Patient Educators
Traditionally pharmacists have a role of dispensing drugs. In multidiscipline care teams, pharmacists provide expertise on drug composition, chemical and biological effects, dosage, and harmful drug combinations. However, the role of pharmacist as educators has been limited to educating patients on the drugs they prescribe. Various programs have encouraged pharmacists to take on the role of patient education.4, 5 In his study, pharmacists were used as educators for risk factors of the cardiovascular disease. Pharmacists have the capacity to influence health outcomes through educating patients.6
Study Design
The study design was adopted from John et al, who discussed how to translate patient education theory into practice.7 Special provisions were incorporated in the study to account for patient literacy levels since Wilson and McLemore have cited literacy as an important factor in designing patient education programs.8 For the study, 25 participants were recruited, 5 patients every day for the first five days of the study. The table below shows the participants demographics and initial health indicator measurements.
A pre-teaching test was conducted by use of a questionnaire and measurement of common health outcomes such as body mass index, blood pressure and concentration of fats in blood. The test focused on the participant’s knowledge of the risk factors of cardiovascular disease and the steps the individuals were taking to minimize the risk of contracting cardiovascular disease. The questionnaire contained two questions; which are the risk factors associated with cardiovascular disease, and how can one minimize exposure to this risk factors?
The health indicators were combined with adiposity measures adopted from Menke et al., to determine obesity prevalence in the participants.9 After the test, I issued informational leaflets and explained the risk factors of cardiovascular disease to all the participants in a one month structured educational program. This ensured standardized intervention among all participants. After one month, the participants repeated the questionnaire test and measurement of health outcomes.
Educational Program Materials
The education program was aimed at providing patients with information on the risk factors of cardiovascular diseases and the ways to minimize these risks. Unlike other programs which use nurse educators and physicians to educate the patients, this study used pharmacists based on their unique qualification to influence health care outcomes and their ability to teach patients. The educational material covered the risk factor explained below.
There are various causes of high blood pressure ranging from eating habits, age, gender and hereditary factors.10 Information on management of these factors will aid in reduction of cardiovascular disease occurrence. Blood vessels blockage and hardness as a result of increase in total cholesterol level in the body and obesity will raise the blood pressure.11 These results to lower activities of the heart, thus the victim is pre-disposed to cardiovascular disease. Information on management of hypertension should be introduced at an early age of child development. Hypertension starts at an early stage of child development and progresses with time.12 To control increase in blood pressure to the risk individual at the right stage, will enhance decrease in cardiovascular disease occurrence. Health living such as eating the right food and proper nutrition will greatly reduce accumulation of fat and cholesterol in the blood vessels. Proper body exercises and change of lifestyles such as excessive intake of alcohol, smoking or even consuming high-fat foods will reduce the risk factors of cardiovascular disease. It is through creating awareness and enhancing effective application of healthy living to the vulnerable people that the mortality rate and occurrence of cardiovascular disease will be controlled. Good eating habits and nutrition information will entail consuming low-fat diets, vegetables, fruits and high-fiber food. This practice facilitates increase in heart activities; maintain normal elasticity of the blood vessels, thus normal rate of blood pressure. Hypertension is also related to aging. Old people will experience high blood pressure due to high levels of cholesterol and rigidity of blood vessels. Hypertension can also be caused by use of drugs such as contraceptives among women which raises the blood pressure.12 Knowledge in use of contraceptive and other forms of drugs will aid in controlling hypertension.
Studies have shown that smoking highly pre-dispose an individual to cardiovascular disease.13 Smoking affects females more as compared to males. This is through creating early onset of menopause whereby significant hormones are no longer produced. The result of smoking to females is myocardial activity disruption. As age progresses, smokers will experience increase in total body cholesterol, thus vulnerable to risk factors of cardiovascular disease on both males and females. Excessive consumption of alcohol will also increase risk factors to the patient. Managing alcohol intake facilitates proper metabolism of lipids and distribution of body fat.
The other main risk factor to cardiovascular disease is diabetes mellitus. It is estimated that about seventy five percent of diabetic patients die as a result of cardiovascular disease. Diabetes increases the risk factors of cardiovascular disease occurrence in both males and females as compared to patients who are non-diabetics. This is due to accumulation of cholesterol due to low lipid metabolism. This indicates that the diabetic victim should receive proper treatment to diseases which act as cardiovascular disease risk factors. Use of drugs such as statin decreases the risk factors causing blood vessel diseases. It is important for the diabetic patient to reduce consumption of sugary food which aids in managing blood pressure as a pre-disposing factor.
Obesity management reduces the risk factors of cardiovascular disease.14 This is through engaging in healthy exercises and healthy living. Excessive distribution of body fat especially around the heart regions and inside blood vessels will increase blood pressure. Therefore it is paramount of the patient to observe proper nutrition to avoid occurrence of obesity. High accumulation of fat around the heart region reduces the activity of the heart, thus occurrence of cardiovascular disease. It is through weight reduction process that level of cholesterol and fat will decrease greatly. This results to normal blood pressure. The normal total cholesterol level in human being as stipulated by World Health Organization is below two hundred. Above this value can act as risk factor to cardiovascular disease occurrence. High total cholesterol level in the blood will result to increased blood pressure, thus hypertension. Inflammation of blood vessels as a result of high total cholesterol and body fat reduces activity of the heart. The victim is predisposed to heart diseases such as atherosclerosis, stroke among others. Body exercises, proper nutrition and medical examination will reduce the risk factors.
It is important for the patient to understand the risk factors of cardiovascular disease. On matters of gender, men are more likely to suffer of cardiovascular disease as compared to women. Estrogen hormones in female aids in reducing total cholesterol level through metabolism of lipids minimizing the risk on women.14 The differences in physical activities, cholesterol distribution, lifestyles and heart rate between male and females determine the pre-disposing factors of cardiovascular disease. On lifestyle, the patients were able to establish means of reducing pre-disposing factors such as high cholesterol level in the body or even obesity.
Study Findings
The participants filled a questionnaire at the beginning of the program to test their awareness of risk factors of the cardiovascular disease. In addition the participants described steps they were taking to prevent contracting cardiovascular disease. The initial average score was 4.7 on a scale of 10 showing that the participants did not have enough information of the cardiovascular disease risk factors. At the end of the one month structured educational program the participants displayed better understanding of the risk factors of cardiovascular disease by having an average score of 7.9 on the same scale. This can be attributed to receiving informational leaflets and teachings from the pharmacist. In response to the acquired information, the participants were found to be taking more steps to minimize the risk of cardio vascular disease. This included replacing high-fat, high-sugar diets with high-fiber, high-vegetable diets, regular exercising and quitting smoking and drinking. Cardiovascular disease education program facilitated the participants to evaluate their daily activities and social life. This is through observing proper nutrition and diets, avoiding excessive consumption of alcohol and body exercises. Risk factors control measures of cardiovascular disease enabled the reduction of mean weight and total body cholesterol of the participants. The improved health outcomes were realized after one month of structured education by a pharmacist.
Conclusion
Cardiovascular disease is treatable through proper management of risk factors such as hypertension, high cholesterol, obesity, diabetes mellitus and kidney diseases. Some risk factors of cardiovascular disease are constant and hard to manage. These include hereditary factors, age and gender. To reduce the vulnerability of the patient, change in lifestyle is paramount. This study evaluated the effects of providing patients with information on the risk factors of the cardio vascular disease and the steps they can take to minimize these risks. The educational program was led by pharmacist and the results reflect significant changes after the education. The participants scored better in post-teaching awareness tests than in the pre-teaching test. This reflects increased knowledge of the risk factors of cardiovascular disease. In addition, most participants were found to be taking practical steps such as dieting, exercising regularly and quitting smoking to minimize the cardiovascular disease risk factors. This demonstrates the success of the program and opens door fro pharmacists to assume more educational duties in order to influence health outcomes.
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