Cost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care

Abstract

Purpose: Review the effectiveness, cost-effectiveness, and implementation challenges of intensive blood pressure (BP) control and team-based care initiatives. Recent Findings: Intensive BP control is an effective and cost-effective intervention, yet implementation in routine clinical practice is challenging. Several models of team-based care for hypertension management have been shown to be more effective than usual care to control BP. Additional research is needed to determine the cost-effectiveness of team-based care models relative to one another and as they relate to implementing intensive BP goals. Summary: As a focus of healthcare shifts to value (i.e., cost, effectiveness, and patient preferences), formal cost-effectiveness analyses will inform which team-based initiatives hold the highest value in different healthcare settings with different populations and needs. Several challenges, including clinical inertia, financial investment, and billing restrictions for pharmacist-delivered services, will need to be addressed in order to improve public health through intensive BP control and team-based care.

Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID‐19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID‐19 Pandemic

“…The panel discussed what must be done to improve healthcare access and “meet patients where they are.” Implementation of proven and effective patient‐centered strategies (such as team‐based and protocolized care with pharmacists and nurses, as well as home BP monitoring) are needed. 33 , 34 The impressive results of the BARBER trial were discussed. In a cluster‐randomized design, the BARBER trial randomly assigned 78 Los Angeles County predominantly Black barbershops and 319 Black male patients to 1 of 2 interventions: (1) a clinical pharmacist‐led intervention, in which Black barbers encouraged patrons with uncontrolled hypertension to meet with specialty‐trained clinical pharmacists who initiated, monitored, and intensified antihypertensive medication therapy, or (2) an active‐control approach, where barbers encouraged lifestyle modification and doctor appointments only to manage hypertension.…”

“… 42 , 43 To do so, we must invest in increasing the implementation of and providing greater access to proven highly effective team‐based care models for hypertension. 32 , 33 We have a steep climb ahead. A recent report found that 40% of patients with uncontrolled hypertension are only taking one antihypertensive medication.…”

“… 58 , 59 , 60 Given the known benefits of home BP monitoring, particularly when paired with team‐based care led by a pharmacist, universal coverage of home BP monitors and hypertension care by ancillary providers could markedly decrease hypertension care and outcome inequities”. 33 , 61 , 62 …”

Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial

“…In conclusion, further studies are however still needed to evaluate, at large scale, how to implement efficiently this TBC model, for example by economic analyses, integrating cost and time estimations to provide the TBC intervention ( 41 ). These studies may offer policymakers additional compelling arguments and open good perspectives for an extensive implementation of the TBC model.…”

Effects of the consumption of proanthocyanidins derived from acacia bark on blood pressure in healthy Japanese adults: A randomized, double-blind, placebo-controlled, parallel-group comparison study

“…In general, SBP reduction is linearly correlated with the risk of developing cardiovascular diseases and death, with the lowest risk at approximately 120-124 mmHg [4]. Moreover, reducing SBP to less than 130 mmHg has been shown to contribute to a reduced risk of cardiovascular disease events [5]. The "Guidelines for the management of hypertension, 2019" published by…”