Cut Your Blood Pressure 3
Condition: Hypertension; High Blood Pressure; African American Men
MeSH terms: Hypertension
Study type: Interventional

Summary: 
      The recently published LA Barbershop in the New England Journal of Medicine (Victor et al. N
      Engl J Med 2018; 378: 1291-301) solid evidence of the efficacy of a pharmacist-led medication
      management intervention to reduce blood pressure in black men that patronize barbershops.

      One of the most significant logistical inefficiencies of the LA Barbershop Study was the
      amount of time the pharmacists spent driving for face-to-face visits with participants. On
      average, each round trip was 40 miles and pharmacists drove 2 hours per day. By using
      telemedicine, the study team can minimize the number of face-to-face in-person visits and
      increase pharmacist efficiency by 25%. the study team aim to increase the scalability of our
      novel, evidence-based barbershop model by addressing this inefficiency with the pilot study.

      In the LA Barbershop trial, each participant averaged 7 in-person visits in 6 months. the
      study team found that the initial in-person visits between the pharmacist, barber, and patron
      were essential for establishing trust as well as obtaining baseline electrolyte and serum
      creatinine levels (with our validated point-of-care device, iSTAT). However, once rapport has
      been established and blood pressure control achieved, the study team postulate that the
      effect can be maintained remotely with telemedicine. Our data indicate that most patients'
      can achieve their blood pressure goal in 3 months or less. the study team propose replacing
      additional in-person visits with telemonitoring (via Skype or FaceTime) at this juncture,
      provided blood chemistries are stable.

      the study team plan to pilot this in 20 patients from 2 to 3 barbershops for 12 months.
    

Detailed description: 
      recently published in the New England Journal of Medicine (Victor et al. N Engl J Med 2018;
      378: 1291-301) solid evidence of the efficacy of a pharmacist-led medication management
      intervention to reduce blood pressure in black men that patronize barbershops.

      the study enrolled a cohort of 319 hypertensive non-Hispanic black male patrons from 52
      black-owned barbershops in Los Angeles County into a cluster-randomized trial in which
      barbershops (non-traditional health care setting) were assigned to either a pharmacist-led
      intervention (in which barbers encouraged in-person meetings with pharmacists who then
      prescribed drug therapy under a collaborative practice agreement with the participants'
      doctors) or an active control approach (in which barbers encouraged lifestyle modification
      and doctor appointments).

      At 6 months, the mean systolic blood pressure fell by 27.0 mmHg in the intervention group and
      by 9.3 mmHg in the control group. A blood pressure level of less than 130/80 was achieved in
      64% of the participants in the intervention versus 12% of participants in the control group.

      the study team are applying for this grant as a first step in transitioning this
      evidence-based intervention into a scalable program. Specifically, the study team will do a
      pilotstudy to test whether the impressive effects on blood pressure can be maintained just as
      well if face-to face meetings are substituted with telemonitoring after blood pressure is at
      goal. If successful this approach would markedly increase efficiency by increasing the number
      of patients a single pharmacist can manage.

      Non-Hispanic black men have the highest rate of hypertension-related death of any racial,
      ethnic, or sex group in the United States. Black men have less physician interaction than
      black women and lower rates of hypertension treatment and control, necessitating community
      outreach. Because black men with hypertension often have multiple cardiovascular risk
      factors, marked reductions in blood pressure - if sustained with the use of our approach and
      then initiated more widely - might reduce the high rates of hypertension-related disability
      and death among black men in the United States.

      The study team want to demonstrate that participants in this pilot can achieve similar blood
      pressure reduction at 12 months (as compared to those in our previous trial) when
      telemedicine is substituted for in-person pharmacist visits after 3 months.
    

Intervention name(s): Blood Pressure measurement and pharmacy
Intervention type(s): Behavioral
Intervention description(s): Blood Pressure monitoring by barber, Blood pressure measurement and management by pharmacist in person and through telemedicine
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment