A Team Model of Hypertension Care in African Americans

描述（由申请人提供）： 尽管药物和非药物治疗有效，但只有不到50%的接受治疗的非洲裔美国患者实现了充分的高血压控制（糖尿病或慢性肾病患者<140/90 mm Hg或<130/80 mm Hg）。研究表明，这一领域缺乏进展的原因有很多，包括患者不依从，次优处方以及患者，医生和药剂师之间的无效沟通。 本研究将在一项随机对照试验中评估组织层面干预的成本效益，该试验涉及密尔沃基和芝加哥地区900例接受治疗的高血压非洲裔美国患者。这项研究将涉及36个社区药房（18个干预组与18个对照组），这些药房由一家在全国经营2,000多家药房的药房公司拥有。干预措施将包括：a）重新定义药剂师和药房技术员的角色，B）实施基于药房的“补充诊所”和工具，以加强对患者和医生的监测和协作，以及c）对药房人员进行血压测量、协作技能和文化能力方面的专门培训/认证。 将在基线、6个月和12个月时测量高血压控制率（主要终点）。研究人员将分析干预的成本效益，建议的做法是否得到实施并随着时间的推移而持续，以及干预影响护理过程的方式（包括药剂师行为，患者报告的障碍，处方方案和患者依从性）。如果干预成功，研究人员将实施和评估一项传播计划，以改善全国高血压患者的药物治疗。这项研究是独一无二的，因为它测试了社区药房中相对简单和低成本的干预措施，社区药房是卫生保健系统中最容易获得的组成部分之一。

DESCRIPTION (provided by applicant): Despite efficacious drug and non-drug treatments, fewer than 50% of treated African American patients achieve adequate hypertension control (<140/90 mm Hg or <130/80 mm HG for patients with diabetes or chronic kidney disease). Studies suggest many reasons for lack of progress in this area, including patient non-adherence, suboptimal prescribing, and ineffective communication among patients, physicians, and pharmacists. This study will evaluate the cost-effectiveness of an organizational-level intervention in a randomized controlled trial involving 900 treated hypertensive African American patients in the Milwaukee and Chicago areas. The study will involve 36 community pharmacies (18 intervention vs.18 control) owned by a pharmacy corporation that operates over 2,000 pharmacies nationwide. The intervention will include: a) redefinition of pharmacist and pharmacy technician roles, b) implementation of a pharmacy-based "refill clinic" and tools for enhanced monitoring and collaboration with patients and physicians, and c) special training/certification of pharmacy personnel in blood pressure measurement, collaborative skills, and cultural competency. Hypertension control rates (primary endpoint) will be measured at- baseline, six months, and 12 months. Researchers will analyze the cost-effectiveness of the intervention, whether the recommended practices were implemented and continued over time, and ways in which the intervention affected the process of care (including pharmacist behavior, patient-reported barriers, prescribed regimens, and patient adherence). If the intervention is successful, researchers will implement and evaluate a dissemination plan for improving pharmacy-based care of hypertensive patients nationwide. The study is unique because it tests relatively simple and low cost interventions in the community pharmacy, an environment which is one of the most readily accessible components of the health care system.