A Team Model of Hypertension Care in African Americans

尽管药物和非药物治疗有效，但接受治疗的非洲裔美国患者中只有不到50% 达到足够的高血压控制（<140/90 mm Hg或<130/80 mm Hg，对于糖尿病患者或 慢性肾病）。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 3.有害。 本研究将在一个随机化的研究中评估组织层面干预的成本效益。 在密尔沃基和芝加哥进行的一项涉及900名接受高血压治疗的非洲裔美国患者的受控试验 地区该研究将涉及36个社区药店（18个干预，18个对照）， 该公司在全国经营着2,000多家药店。干预措施将包括： B）实施基于药房的“补充诊所”和工具， 加强监测以及与病人和医生的合作，以及c）对 药学人员在血压测量，协作技能和文化能力。 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措施的成本效益， 实施并持续一段时间，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 干预是成功的，研究人员将实施和评估传播计划，以改善 在全国范围内为高血压患者提供以药房为基础的护理。这项研究是独一无二的，因为它测试了相对 社区药房的简单和低成本干预措施，这是一个最重要的环境之一， 卫生保健系统中容易获得的组成部分。

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 nonadherence, suboptimal prescribing, and ineffective communication among patients, physicians, and 3harmacists. This study will evaluate the cost-effectiveness of an organizational-level intervention in a randomized sontrolled trial involving 900 treated hypertensive African American patients in the Milwaukee and Chicago areas. The study will involve 36 community pharmacies (18 intervention, 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 implemement 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.