| Course | HCR 400 Evidence-Based Practice for the Health Care Professional |
|---|---|
| Module | Module 7 |
| Paper type | Evidence-based practice project paper |
| Length | About 1,040 words, 6 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | BS in Health Care Coordination |
| Updated | October 2026 |
Free sample paper for HCR 400 Module 7
Readings From Home, Decisions by the Team: An Evidence-Based Proposal for Hypertension Control
Student Name
BS in Health Care Coordination, Arizona State University
HCR 400: Evidence-Based Practice for the Health Care Professional
Instructor Name
Month Day, Year
Readings From Home, Decisions by the Team: An Evidence-Based Proposal for Hypertension Control
Introduction
Primary care teams manage high blood pressure every day, and national survey data show it is more prevalent among men and among non-Hispanic Black adults (Ostchega et al., 2020). Lowering blood pressure prevents strokes, heart attacks and deaths, and treating high-risk patients to a tighter goal cut both major cardiac events and overall mortality in a landmark trial (SPRINT Research Group, 2015). Yet many patients remain uncontrolled because clinic visits are infrequent and treatment is not adjusted often enough. Our clinic network sees this pattern daily, which led our group to ask whether home monitoring could help.
PICOT Question
Among primary care adults whose blood pressure remains above goal (P), does a program in which pharmacists or nurses review transmitted home readings and change medicines (I), compared with care based on office visits (C), increase the proportion at goal (O) by twelve months (T)?
Search Methods
We searched PubMed, CINAHL and the Cochrane Library using combinations of hypertension, home or self-measured blood pressure, telemonitoring, pharmacist and team-based care, limited to adults and English. From the results of five search strings, we selected ten articles that addressed our question, prioritizing systematic reviews and randomized trials and including one long-term follow-up and one source of national prevalence data.
Summary of the Evidence
Systematic reviews. Uhlig et al. (2013) reviewed 52 comparative studies. Self-measurement on its own helped for about half a year and then faded, whereas self-measurement backed by additional support showed a durable, high-strength advantage at one year. Tucker et al. (2017) pooled individual patient data from randomized trials and found that self-monitoring lowered clinic systolic pressure by about 3 mm Hg at 12 months, with little effect alone and about 6 mm Hg when combined with intensive support.
Trials of monitoring with pharmacist support. In the e-BP trial of 778 patients, home monitoring with web training alone did not significantly improve control, 36 percent compared with 31 percent in usual care, but adding web-based pharmacist care raised control to 56 percent (Green et al., 2008). Across 16 Minnesota clinics randomized as units, patients who sent readings to pharmacists managing their medicines were controlled at both the 6- and 12-month checks in a little over half of cases, nearly double the usual-care rate (Margolis et al., 2013).
Trials of self-management and telemonitoring. In TASMINH2, self-monitoring with self-titration of medicines and telemonitoring left systolic pressure about five points lower than usual care after a year (McManus et al., 2010). In TASMINH4, with 1,182 patients in 142 practices, physicians who adjusted medicines using self-monitored readings achieved lower systolic pressure at 12 months than those using clinic readings, by 3.5 mm Hg with self-monitoring and 4.7 mm Hg with telemonitoring, with no significant difference between the two monitoring groups (McManus et al., 2018).
Community setting. In Los Angeles barbershops, men whose barbers linked them to pharmacists able to prescribe saw systolic readings fall nearly three times as far over six months as men who only received encouragement (Victor et al., 2018).
Durability. A follow-up of the Margolis trial found that benefits persisted for up to 24 months, a year after the intervention ended, but the difference at 54 months was small and not significant, suggesting that support must continue (Margolis et al., 2018).
Evidence Table
| Source | Design | Key finding | Level |
|---|---|---|---|
| Uhlig et al. (2013) | Systematic review | Support sustains benefit at 12 months | High |
| Tucker et al. (2017) | Individual patient data meta-analysis | Effect grows with intensity of support | High |
| Green et al. (2008) | RCT, 778 patients | Pharmacist care raised control to 56 percent | High |
| Margolis et al. (2013) | Cluster RCT, 450 patients | Control 57.2 vs 30.0 percent | High |
| McManus et al. (2010) | RCT, 527 patients | 5.4 mm Hg greater fall at 12 months | High |
| McManus et al. (2018) | RCT, 1,182 patients | Self-monitored titration beats clinic readings | High |
| Victor et al. (2018) | Cluster RCT, 319 men | Large fall with pharmacist in barbershops | High |
| Margolis et al. (2018) | Follow-up of RCT | Effect lasted about 24 months | Moderate |
| SPRINT Research Group (2015) | RCT, 9,361 adults | Lower targets reduce events in high-risk adults | High |
| Ostchega et al. (2020) | National survey data | Prevalence and disparities | Background |
Synthesis
Three conclusions emerge. First, monitoring alone is not enough: the meta-analyses and the e-BP trial show small or short-lived effects without support. Second, monitoring combined with someone who acts on the readings, a pharmacist, nurse or physician adjusting treatment, produces larger and clinically meaningful improvements in control. Third, benefits fade after support ends, so programs must be sustained. The evidence also suggests that the channel matters less than the action: telemonitoring and self-monitoring performed similarly in TASMINH4 when readings were used to adjust treatment. Gaps remain in long-term clinical outcomes and in evidence for patients without internet access.
Proposed Solution
We recommend that our clinic network implement home blood pressure telemonitoring with pharmacist or nurse management for adults with uncontrolled hypertension. Eligible patients would receive a validated cuff and training; readings would be transmitted weekly to a clinical pharmacist or nurse who adjusts medications under a physician-approved protocol and contacts patients when readings are high. Patients without internet would report readings by phone. Support would continue rather than end at 12 months, given the follow-up evidence.
Implementation
Stakeholders include physicians, pharmacists, nurses, information technology staff, billing staff and patients. Steps include writing the treatment protocol, training staff, purchasing cuffs, setting up data transmission into the electronic health record and identifying eligible patients through registry reports. Barriers include device cost, staff time and reimbursement; remote monitoring billing codes and pharmacist collaborative practice agreements can address some of these. Cultural considerations include partnering with trusted community settings for patients who rarely visit clinics.
Evaluation
Measures will include the percentage of enrolled patients at target at the six- and twelve-month marks, set against similar patients not enrolled, mean change in systolic pressure, number of medication adjustments, patient satisfaction and staff time. Results will be reviewed quarterly.
Conclusion
Ten sources show that home blood pressure monitoring improves control when someone acts on the readings and that support must continue to keep the benefit. Implementing telemonitoring with pharmacist or nurse management offers our clinic network an evidence-based way to help more patients reach control.
References
Green, B. B., Cook, A. J., Ralston, J. D., Fishman, P. A., Catz, S. L., Carlson, J., Carrell, D., Tyll, L., Larson, E. B., & Thompson, R. S. (2008). Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: A randomized controlled trial. JAMA, 299(24), 2857-2867. https://doi.org/10.1001/jama.299.24.2857
Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., Kerby, T. J., Klotzle, K. J., Maciosek, M. V., Michels, R. D., O'Connor, P. J., Pritchard, R. A., Sekenski, J. L., Sperl-Hillen, J. M., & Trower, N. K. (2013). Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: A cluster randomized clinical trial. JAMA, 310(1), 46-56. https://doi.org/10.1001/jama.2013.6549
Margolis, K. L., Asche, S. E., Dehmer, S. P., Bergdall, A. R., Green, B. B., Sperl-Hillen, J. M., Nyboer, R. A., Pawloski, P. A., Maciosek, M. V., Trower, N. K., & O'Connor, P. J. (2018). Long-term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension: Follow-up of a cluster randomized clinical trial. JAMA Network Open, 1(5), e181617. https://doi.org/10.1001/jamanetworkopen.2018.1617
McManus, R. J., Mant, J., Bray, E. P., Holder, R., Jones, M. I., Greenfield, S., Kaambwa, B., Banting, M., Bryan, S., Little, P., Williams, B., & Hobbs, F. D. R. (2010). Telemonitoring and self-management in the control of hypertension (TASMINH2): A randomised controlled trial. The Lancet, 376(9736), 163-172. https://doi.org/10.1016/S0140-6736(10)60964-6
McManus, R. J., Mant, J., Franssen, M., Nickless, A., Schwartz, C., Hodgkinson, J., Bradburn, P., Farmer, A., Grant, S., Greenfield, S. M., Heneghan, C., Jowett, S., Martin, U., Milner, S., Monahan, M., Mort, S., Ogburn, E., Perera-Salazar, R., Shah, S. A., . . . Hobbs, F. D. R. (2018). Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): An unmasked randomised controlled trial. The Lancet, 391(10124), 949-959. https://doi.org/10.1016/S0140-6736(18)30309-X
Ostchega, Y., Fryar, C. D., Nwankwo, T., & Nguyen, D. T. (2020). Hypertension prevalence among adults aged 18 and over: United States, 2017-2018 (NCHS Data Brief No. 364). National Center for Health Statistics. https://www.cdc.gov/nchs/products/databriefs/db364.htm
SPRINT Research Group. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103-2116. https://doi.org/10.1056/NEJMoa1511939
Tucker, K. L., Sheppard, J. P., Stevens, R., Bosworth, H. B., Bove, A., Bray, E. P., Earle, K., George, J., Godwin, M., Green, B. B., Hebert, P., Hobbs, F. D. R., Kantola, I., Kerry, S. M., Leiva, A., Magid, D. J., Mant, J., Margolis, K. L., McKinstry, B., . . . McManus, R. J. (2017). Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLOS Medicine, 14(9), e1002389. https://doi.org/10.1371/journal.pmed.1002389
Uhlig, K., Patel, K., Ip, S., Kitsios, G. D., & Balk, E. M. (2013). Self-measured blood pressure monitoring in the management of hypertension: A systematic review and meta-analysis. Annals of Internal Medicine, 159(3), 185-194. https://doi.org/10.7326/0003-4819-159-3-201308060-00008
Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., Brettler, J., Rashid, M., Hsu, B., Foxx-Drew, D., Moy, N., Reid, A. E., & Elashoff, R. M. (2018). A cluster-randomized trial of blood-pressure reduction in Black barbershops. New England Journal of Medicine, 378(14), 1291-1301. https://doi.org/10.1056/NEJMoa1717250
Reading the HCR 400 Module 7 assignment instructions
Worth 100 of 450 points, the Final EBP Project Paper is the largest graded item in HCR 400 and is due on the last day of term together with the group evaluation. The syllabus says the paper presents a summary of the ten articles the group selected in weeks 3 and 4 and a solution to the problem studied, and the course as a whole aims for learners to develop a project highlighting a new health care standard. Build from your outline, your instructor's feedback, your evidence tables and your appraisals. Because several people write the paper, agree early on terminology, citation style and voice so that the finished document reads as one argument.
Inside the HCR 400 Module 7 example
Opening on why uncontrolled blood pressure matters to the clinic network, the paper states the PICOT question and describes the search. Its evidence summary groups the ten sources by the question each answers: the two meta-analyses, trials pairing monitoring with pharmacist support, trials of self-management, a community-based trial and a long-term follow-up. An evidence table records design, key finding and level for every source. The synthesis draws three conclusions and names remaining gaps, after which the proposed solution, implementation and evaluation sections turn the evidence into a plan for the group's clinic network. The conclusion restates the recommendation and the evidence behind it.
Reading the HCR 400 Module 7 grading rubric
The final paper is marked on a 100-point Canvas rubric. Credit usually follows a precise PICOT question, a transparent search, accurate summaries of all ten sources, an evidence table, a synthesis that reaches conclusions across studies, a solution that is specific and feasible, implementation and evaluation plans, attention to barriers and to cultural considerations and consistent APA style across every member's section. Deductions are common when each source gets its own paragraph and no cross-study conclusions emerge, when the recommendation outruns the evidence, when evaluation is missing and when the sections plainly come from different hands. A brief limitations paragraph acknowledging gaps in the evidence, such as short follow-up or missing clinical outcomes, also signals mature judgment.
HCR 400 Module 7 help: mistakes that cost marks
Draft the synthesis before polishing individual summaries, since it determines what each summary needs to say. Check that the recommended solution follows directly from the evidence presented. Let the evidence table carry the detail so the prose can stay brief. Name barriers frankly and say how the clinic would address each. Assign one member to read the whole paper for consistency in terms, numbers and tone. If your group wants an outside reader, the desk can review the draft against the ten-source and solution requirements. Before submission, read the paper aloud as a group or at least have two members read it separately, marking any place where a term, number or recommendation does not match another section.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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HCR 400 Module 7 questions, answered
Where can I find a free HCR 400 Module 7 sample paper?
A full HCR 400 Module 7 sample is on this page: a final EBP project paper proposing that pharmacists or nurses act on patients' home blood pressure readings.
How much is the HCR 400 final EBP paper worth?
It is worth 100 of the course's 450 points.
How many articles does the HCR 400 final paper use?
Ten articles chosen by the group in weeks 3 and 4.
Does home blood pressure telemonitoring work?
Trials show larger improvements in control when a pharmacist or nurse acts on the readings than with monitoring alone.
When is the HCR 400 final paper due?
On the last day of the term, together with the group evaluation of the EBP project.