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

描述（由申请人提供）：高血压（HTN）对非西班牙裔黑人男性来说是毁灭性的，他们的HTN患病率高于其他人群，但与医生接触较少，参与干预试验较少。我们之前在黑人拥有的理发店中进行了HTN干预的第一次集群随机试验。商店被随机分为对照组（HTN小册子）和干预组，其中理发师（值得信赖的同行）为成年黑人男性顾客提供血压（BP）检查，并鼓励血压高的人预约医生。10个月后，我们发现干预效果很小。初级保健提供者对HTN治疗不足，限制了以理发为基础的干预降低血压的能力。因此，我们现在将理发师为基础的干预与药剂师为基础的团队护理联系起来，以优化HTN的管理。我们与Kaiser Permanente （KP）和Walgreens合作，提出了一项新的试验，其具体目标如下：目的：评价强化干预的效果

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.