Barber-Pharmacist Coordination to Improve Blood Pressure Management in Black Men

理发师与药剂师协调改善黑人血压管理

基本信息

批准号：
8870419
负责人：
Ronald G Victor
金额：
$ 304.91万
依托单位：
CEDARS-SINAI MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-15 至 2019-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8870419
关键词：
Address Adult Affect Agreement Appointment Authorization documentation Blood Pressure Businesses California Caring Cessation of life Clinical Pharmacists Clinical Trials Cluster randomized trial Collaborations Communities Country Data Effectiveness Enrollment Ensure Epidemic Federally Qualified Health Center Funding Gender Generic Drugs Health Health Care Costs Health Care Reform Health Promotion Health Services Research Health system Healthcare Heart failure High Prevalence Hybrids Hypertension Hypotension Intervention Intervention Trial Kidney Failure Laws Left Link Los Angeles Medical Methodology Modeling Myocardial Infarction National Heart, Lung, and Blood Institute Not Hispanic or Latino Outcome Pamphlets Patients Persons Pharmaceutical Preparations Pharmacists Pharmacotherapy Pharmacy facility Physicians Pilot Projects Play Policies Population Prevalence Primary Health Care Provider Public Health Race Randomized Reading Resources Risk Factors Role Safety Services Stroke System Telephone Testing Training Translating Translations Trust Woman Work arm base blood pressure reduction blood pressure regulation care delivery cohort combat comparison group cost cost effectiveness design disability follow-up group intervention hypertension control hypertension treatment improved innovation intervention effect male medical specialties meetings member men novel outreach peer policy implication primary outcome programs prospective role model

项目摘要

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：高血压（HTN）对非西班牙裔黑人的毁灭性，他们的HTN患病率高于其他群体，但医师接触较少，参与干预试验的参与较少。我们以前在黑人拥有的理发店中进行了HTN干预的第一个集群伴随的三层。商店被随机分配给对照组（HTN小册子）或干预臂，理发师（值得信赖的同龄人）向成年黑人男性顾客提供血压（BP）检查，并激发了BP高的人进行医生预约。 10个月后，我们发现了较小的干预效果。初级保健提供者对HTN的处理不足限制了基于理发的干预措施降低BP的能力。因此，我们现在将基于理发师的干预措施与基于药剂师的团队护理联系起来，以优化HTN管理。与Kaiser Permanente（KP）和Walgreens合作，我们提出了一项新的试验，其特定目的：1。评估增强干预的功效通过进行集群随机试验，收缩BP。将筛选20个洛杉矶（LA）理发店的客户的客户，以收集每家商店的25名顾客，并与不受控制的HTN收集。十家商店（250个顾客）将被分为一个比较人组（HTN小册子）和10家商店（250个顾客），为一个干预小组，理发师经常检查和传递注册顾客的BP读数，并激励他们对药剂师进行跟进。通过医生的许可和监督，药剂师将促进患者的激活，根据协作实践协议加强药物治疗，向医师发送进度票据，并在每次药物更改后进行跟进。主要终点是6个月后评估的收缩压变化。我们假设接受理发师干预的理发店顾客将比在比较小组中接受标准的HTN小册子和常规医疗服务的顾客要比顾客更大。 2。通过一项为期6个月的扩展研究评估可持续性和安全性。与与药剂师的面对面相遇，干预措施将继续使用更多的电话。我们假设对收缩压的干预效果至少可以安全维持至少6个月。 3。在实施试点研究中评估现实世界的有效性和可采用性。如果要满足试验的6个月主要结果，我们将：a）分析定性数据以告知实施； b）在现实情况下，通过针对其成员转介给KP的三个州以及非KP患者的Walgreens商店在现实世界中的有效性（n = 300人）； c）从通用的医疗保健付款人角度来看，模型成本效益将观察到的BP减少转化为成本偏移预测； d）使用内部公司特定的成本数据修改这些预测，以确定是否可以开发可行的业务模型。实施将支持可负担得起的护理法案倡议促进系统，其中提供商对成本，质量和成果负责。甚至5 mmHg的收缩BP的持续减少将减少影响黑人男性的HTN控制的差异。