Team-Based Care and Improved Blood Pressure Control

Abstract

Context Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes. Evidence acquisition An existing systematic review (search period, January 1980–July 2003) assessing team-based care for BP control was supplemented with a Community Guide update (January 2003–May 2012). For the Community Guide update, two reviewers independently abstracted data and assessed quality of eligible studies. Evidence synthesis Twenty-eight studies in the prior review (1980–2003) and an additional 52 studies from the Community Guide update (2003–2012) qualified for inclusion. Results from both bodies of evidence suggest that team-based care is effective in improving BP outcomes. From the update, the proportion of patients with controlled BP improved (median increase=12 percentage points); systolic BP decreased (median reduction=5.4 mmHg); and diastolic BP also decreased (median reduction=1.8 mmHg). Conclusions Team-based care increased the proportion of people with controlled BP and reduced both systolic and diastolic BP, especially when pharmacists and nurses were part of the team. Findings are applicable to a range of U.S. settings and population groups. Implementation of this multidisciplinary approach will require health system–level organizational changes and could be an important element of the medical home.

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

“…[2][3][4] Although many types of interventions to improve BP control have been tested over the last several decades, the most potent methods involve a reorganization of clinical practice to include nurses or pharmacists in a team-based approach to hypertension care. [5][6][7][8][9] Home BP monitoring has also been found to be a useful adjunct to team-based care for hypertension. 10 We have reported the main results of a cluster-randomized trial that compared usual care to an intervention combining home BP telemonitoring and pharmacist management.…”

Community Guide Cardiovascular Disease Economic Reviews: Tailoring Methods to Ensure Utility of Findings

“…For the top five prioritized interventions, systematic reviews were first undertaken of their effectiveness in achieving their intended outcomes. 1,2,4–7 According to Community Guide processes, since the Task Force recommended all five interventions based on evidence of their effectiveness, systematic economic reviews were subsequently completed. 3,5,8,9 …”

Novel players in cardioprotection: Insulin like growth factor-1, angiotensin-(1–7) and angiotensin-(1–9)

“…Emerging evidence suggests beneficial effects of IGF-1 [18], angiotensin- (1)(2)(3)(4)(5)(6)(7) [(Ang-(1-7)] and angiotensin- (1)(2)(3)(4)(5)(6)(7)(8)(9) [Ang- (1)(2)(3)(4)(5)(6)(7)(8)(9)] [22] on the CV system. This review summarizes our current understanding regarding their signaling pathways focused on cardiac function.…”

“…Of the 57 million global deaths in 2008, 17 million or 30%, were due to CVD [1]. HT, defined as having systolic blood pressure 140 mmHg or diastolic blood pressure 90 mmHg at two or more office visits or current use of blood pressure (BP)-lowering medications [2,3], remains the predominant risk factor for cardiovascular (CV) mortality worldwide [4,5]. Globally, 7.6 million premature deaths and 92 million disability adjusted life-years are attributable to elevated BP [4].…”