Hypertension (HTN) is devastating to non-Hispanic black men, who have a higher HTN prevalence than other groups but less physician contact and less participation in intervention trials. We previously conducted the first cluster-randomized tril of a HTN intervention in black-owned barbershops. Shops were randomized to a control arm (HTN pamphlets) or an intervention arm in which barbers (trusted peers) offered blood pressure (BP) checks to adult black male patrons and motivated those with high BP to make doctor appointments. After 10 months, we found a small intervention effect. Under-treatment of HTN by primary care providers limited the ability of the barber-based intervention to lower BP. Thus, we now have linked the barber-based intervention to pharmacist-based team care to optimize HTN management. In collaboration with Kaiser Permanente (KP) and Walgreens, we propose a new trial with the following specific aims: 1. To evaluate the efficacy of the enhanced intervention on systolic BP by conducting a cluster-randomized trial. The clientele of 20 Los Angeles (LA) barbershops will be screened to collect a cohort of 25 patrons per shop with uncontrolled HTN. Ten shops (250 patrons) will be randomized to a comparator group (HTN pamphlets) and 10 shops (250 patrons) to an intervention group in which barbers frequently check and transmit BP readings of enrolled patrons and motivate them to follow-up with pharmacists. With physicians'permission and oversight, pharmacists will promote patient activation, intensify drug therapy under a collaborative practice agreement, send progress notes to physicians, and follow up after each medication change. The primary endpoint is the change in systolic BP assessed after 6 months. We hypothesize that barbershop patrons who receive the barber- pharmacist intervention will have a greater reduction in systolic BP than patrons in the comparison group who receive standard HTN pamphlets and usual medical care. 2. To evaluate sustainability and safety with a 6- month extension study. The intervention will continue with more phone than in-person encounters with pharmacists. We hypothesize that the intervention effect on systolic BP can be sustained safely for at least 6 more months. 3. To evaluate real-world effectiveness and adoptability in an implementation pilot study. If the trial's 6-month primary outcome is met, we will: A) analyze qualitative data to inform implementation;B) evaluate effectiveness under real-world conditions with a pilot implementation study (n=300 men) in three states that involves referral to KP for their members, and to Walgreens stores for non-KP patients;C) model cost-effectiveness from a generic health care payer perspective to translate observed BP reductions into cost- offset projections;and D) modify these projections using internal corporate-specific cost data to determine if viable business models can be developed. Implementation would support Affordable Care Act initiatives promoting systems in which providers are fiscally responsible for cost, quality and outcomes. Sustained reductions in systolic BP of even 5 mmHg would reduce the disparity in HTN control affecting black men.
Our previous study showed that barbers, as trusted peers, can help combat the epidemic of high blood pressure in their black male customers by offering free blood pressure checks with haircuts and encouraging customers with high blood pressure to seek treatment by a doctor. To make the barbers'health promotion program more effective and to incorporate it into healthcare reform, a new study is proposed in which barbers will now refer their customers with high blood pressure to trained community-based clinical pharmacists who, with doctors'approval and oversight, will provide specialty-level healthcare. Incorporating this novel public health program into barbershops and healthcare networks across the country could substantially reduce health care costs and reduce the disproportionate disability and death black men suffer from high blood pressure.
|Fontil, Valy; Bibbins-Domingo, Kirsten; Kazi, Dhruv S et al. (2015) Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model. J Gen Intern Med 30:1147-55|