title: Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis.
abstract: OBJECTIVE
  To determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP).
  
  
  METHODS
  Cross-sectional analytical study.
  
  
  METHODS
  Administrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses.
  
  
  METHODS
  76,797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics.
  
  
  METHODS
  Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE.
  
  
  RESULTS
  The prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99).
  
  
  CONCLUSIONS
  A CPE, perceived by PHC nurses as more favourable, and more patient-nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed.
authors.affiliation: Department of Nursing, Department of Preventive Medicine and Public Health, Department of Surgery, School of Medicine, Universidad Autónoma de Madrid/IISPHM, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Parro-Moreno
authors.affiliation: Department of Nursing, School of Medicine, Universidad Autónoma de Madrid/IDIPHIM/INAECU, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Serrano-Gallardo
authors.affiliation: Information System Unit, Directorate for Public Health, Health Service of Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Díaz-Holgado
authors.affiliation: Information System Unit, Directorate for Public Health, Health Service of Madrid, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Aréjula-Torres
authors.affiliation: Clinical Biostatistics of Ramón y Cajal University Hospital/IRYCIS/Centre for Biomedical Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Abraira
authors.affiliation: Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain/IBIMA, A Coruña, Santiago de Compostela, Spain.
authors.forename: Isolina M
authors.initials: IM
authors.lastname: Santiago-Pérez
authors.affiliation: Faculty of Health Sciences, Universidad de Málaga, Málaga, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Morales-Asencio
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D015999:Multivariate Analysis; D009723:Nurse-Patient Relations; D009726:Nurses / Q000592:standards*; D017060:Patient Satisfaction; D059017:Primary Care Nursing / Q000592:standards*; D012044:Regression Analysis; D012923:Social Class; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Nursing Work Index; Nursing workforce; PRIMARY CARE