Differential treatment of hypertension by primary care providers and hypertension specialists in a barber-based intervention trial to control hypertension in Black men.
Differential treatment of hypertension by primary care providers and hypertension specialists in a barber-based intervention trial to control hypertension in Black men.
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初级保健提供者和高血压专家在一项基于理发师的干预试验中对高血压进行差异化治疗，以控制黑人男性的高血压。
DOI：
10.1016/j.amjcard.2013.07.004
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Victor,RonaldG
中科院分区：
文献类型：
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作者：
Rader,Florian;Elashoff,RobertM;Niknezhad,Sara;Victor,RonaldG
黑人男性与医生的接触比其他群体少，因此高血压治疗和控制率较低。在理发师辅助降低少数民族居民血压的试验中，8家积极干预理发店的高血压控制情况比7家对照店略有改善，理发师在理发时提供血压（BP）检查，并激励高血压的黑人男性顾客寻求提供者随访，顾客收到高血压小册子，但没有理发师血压检查。在初级保健中常见的高血压治疗不足可能会影响结局。因此，在基线收缩压≥140 mm Hg和10个月随访（包括血压和药物数据）的顾客中，我们对初级保健提供者（PCP）治疗的对照组患者（n = 68）与（1）PCP治疗的干预组患者（n = 37）或（2）干预组患者（n = 33）之间的收缩压降低进行了事后比较。他们无法获得PCP，并由高血压专科医生作为安全网提供者进行治疗。后一组的基线收缩压高于其他组（分别为162 ± 3 vs 155 ± 2和154 ± 2 mm Hg，p <0.01）。在调整基线收缩压和其他协变量后，当理发师将顾客推荐给高血压专家时，收缩压降低21 ± 4 mm Hg，比对照组高（p <0.0001），但当他们提到PCP时没有差异（4 ± 4 mm Hg，p = 0.31）。专家治疗的顾客接受更多的BP药物和不同类别的药物比PCP治疗的顾客。总之，理发师为基础的干预，如果直接连接到专业水平的医疗保健，可能有一个大的公共卫生影响高血压疾病的黑人男性。
Black men have less physician contact than other groups and thus lower rates of hypertension treatment and control. In the Barber-Assisted Reduction in Blood Pressure among Ethnic Residents trial, hypertension control in 8 active-intervention barbershops where barbers offered blood pressure (BP) checks with haircuts and motivated black male patrons with high BP to seek provider follow-up showed a small improvement over that in 7 comparison shops where patrons received hypertension pamphlets but not barber-BP checks. Undertreatment of hypertension, which is common in primary care, may have impacted the outcomes. Thus, in patrons with a baseline systolic BP of ≥140 mm Hg and 10-month follow-up including BP and medication data, we performed post hoc comparison of systolic BP reduction between comparison-arm patrons (n = 68) treated by primary care providers (PCPs) with (1) intervention-arm patrons (n = 37) treated by PCPs or (2) intervention-arm patrons (n = 33) who lacked access to PCPs and were treated by hypertension specialist physicians serving as safety net providers. The latter group had higher baseline systolic BP than the others (162 ± 3 vs 155 ± 2 and 154 ± 2 mm Hg, respectively, p <0.01). After adjustment for baseline systolic BP and other covariates, systolic BP reduction was 21 ± 4 mm Hg greater than in the comparison group (p <0.0001), when barbers referred patrons to hypertension specialists but was no different when they referred to PCPs (4 ± 4 mm Hg, p = 0.31). Specialist-treated patrons received more BP medication and different classes of medication than PCP-treated patrons. In conclusion, the barber-based intervention—if connected directly to specialty-level medical care—could have a large public health impact on hypertensive disease in black men.