Team-based care increased the proportion of people with controlled BP  and reduced both systolic and diastolic BP , especially when pharmacists and nurses were part of the team .
CONTEXT Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care , established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient .
Team-based care has the potential to improve the quality of hypertension management .
The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure ( BP ) outcomes .
Hypertension Improvement Project (HIP): study protocol and implementation challenges
Background Hypertension affects 29 % of the adult U.S. population and is a leading cause of heart disease , stroke , and kidney failure . Despite numerous effective treatments , only 53 % of people with hypertension are at goal blood pressure . The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care . Methods and design This paper describes the protocol of a nested 2 × 2 r and omized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients  and a  quality improvement-type intervention for physicians .  Primary care practice s were r and omly assigned to the physician intervention or to the physician control condition . Physician r and omization occurred at the clinic level . The physician intervention included training and performance monitoring . The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension . Performance data were collected for 18 months , and feedback was provided to physicians every 3 months . Patient participants in both intervention and control clinics were individually r and omized to the patient intervention or to usual care . The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions , followed by 12 monthly phone contacts by community health advisors . Follow-up measurements were performed at 6 and 18 months . The primary outcome was the mean change in systolic blood pressure at 6 months . Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months . Discussion Overall , 8 practice s ( 4 per treatment group ) , 32 physicians ( 4 per practice ; 16 per treatment group ) , and 574 patients ( 289 control and 285 intervention ) were enrolled . Baseline characteristics of patients and providers and the challenges faced during study implementation are presented . The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model . The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately , so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local re sources .Trial registration Clinical Trials.gov identifier
Team-based care increased the proportion of people with controlled BP  and reduced both systolic and diastolic BP , especially when pharmacists and nurses were part of the team .
CONTEXT Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care , established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient .
Team-based care has the potential to improve the quality of hypertension management .
The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure ( BP ) outcomes .