麻豆果冻传媒影音

ORLANDO – Bringing high blood pressure control programs aimed at hard-to-treat African American men to the local neighborhood barbershop – with an embedded prescribing pharmacist – produced an astounding average drop in blood pressure among men with uncontrolled hypertension, researchers reported here.

At barbershops where pharmacists doled out hypertensive medicines with approval of the patient's primary care physician, mean systolic blood pressure fell from 153 mm Hg to 126 mm Hg after 6 months, reported Ronald Victor, MD, of the University of California Los Angeles.

That was significantly different than in men patronizing a control group of barbershops where owners advocated usual care – seeing a doctor and improving lifestyle – where average systolic blood pressure declined by 9 mm Hg (P<0.001) at 6 months, Victor reported at the annual scientific sessions of the American College of Cardiology. The findings were also published in the New England Journal of Medicine.

He said that African American men are difficult to treat because they do not visit healthcare facilities as often as other groups, including African American women. Hence, he and his colleagues decided to bring the medicine to where the men often regularly congregated – their local barbershop which has been a social center in the black neighborhood for decades and where the barber is a trusted community leader.

"Non-Hispanic black men have the highest hypertension rate in the United States," Victor said in explaining how the study was designed. "Black men have less physician interaction than black women and thus lower rates of treatment and control of hypertension. Health outreach in barbershops is well established throughout the United States."

Researchers identified 28 long-time neighborhood barbershops and asked the barbers to promote follow-up with specialty-trained pharmacists. The pharmacists met the barbershop patrons monthly at the shops where they checked blood pressure, prescribed medication in a collaborative practice with the patrons' primary care physicians, monitored electrolytes using a fingerstick method, and sent progress notes to the patrons' physicians. The barbershops with the pharmacists took care of 132 men in the study.

At another set of 24 barbershops, the barbers promoted follow-up with primary care physicians and suggested lifestyle changes to their patrons. There were 171 men included in this group.

"This is a home run," said Eileen Handberg, PhD, ARNP, of the University of Florida, Gainesville, who discussed the trial results at a press conference. "This is something that clinical trialists dream of – to get this kind of impact in healthcare. This is taking care to where patients live. This is high touch medicine."

"We could not have done this study without the terrific buy-in by the barbers," Victor said.

Participants were regular customers of the 52 barbershops in Los Angeles County that were involved in the study. Mean age was 54; about half were married; 20% were college graduates; about 35% had annual incomes of less than $25,000 a year; some 80% had a regular medical provider.

Overall, Victor reported that 63.6% of the men in the intervention group achieved blood pressure goals compared with 11.7% of the men in the usual care group (P<0.001).

In general, hypertensive men were prescribed amlodipine plus irbesartan as the first step of treatment, with a diuretic added as the second step. If needed an aldosterone antagonist was added in a third treatment step.

Victor told MedPage Today, "California was one of the first states that allowed pharmacists to prescribe drugs but now 44-45 states have the same law. We provide some specialty training to our pharmacists in this study to deal with hypertensive patients. With the type of success we saw in this project, it would be a no-brainer for third party payers to reimburse these programs."

The study was funded by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health, among other funding sources.

"There are other professionals who can do this as well, such as physicians assistants and nurse practitioners," Handberg told MedPage Today. "There are a lot of team members who can do this and get reimbursed for it. The barbershop is where it is happening. We have to get people out of the clinic office to deliver care."

Comment