Economics of Team-based Care in Controlling Blood Pressure

Jacob, Verughese; Chattopadhyay, Sajal K.; Thota, Anilkrishna B.; Proia, Krista; Njie, Gibril J.; Hopkins, David P.; Finnie, Ramona; Pronk, Nicolaas P.; Kottke, Thomas E.

doi:10.1016/j.amepre.2015.04.003

Cited by 37 publications

(39 citation statements)

References 53 publications

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“…13 Studies of SMBP within TBC included in the present review do not provide evidence for the contribution of SMBP to the effectiveness or cost effectiveness of TBC because the studies compared SMBP within TBC to usual care. However, SMBP is a common component of TBC for BP control, as it provides a regular and ongoing activity to engage patients in their own care.…”

Section: Discussionmentioning

confidence: 97%

“…An intervention is considered cost effective if the cost per QALY saved is less than a conservative threshold of $50,000. 11,12 The present review translated reductions in SBP to QALYs saved 13 to assess cost effectiveness for studies that reported the change in BP resulting from intervention. Two translations from the published literature were used: Translation (1), for which a reduction of 1 mmHg of SBP=0.009 QALY saved 14 ; and Translation (2), for which a reduction of 1 mmHg of SBP=0.093 QALY saved.…”

Section: Evidence Acquisitionmentioning

confidence: 99%

See 1 more Smart Citation

Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review

Jacob

Chattopadhyay

Proia

et al. 2017

American Journal of Preventive Medicine

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Context The health and economic burden of hypertension, a major risk factor for cardiovascular disease, is substantial. This systematic review evaluated the economic evidence of self-measured blood pressure (SMBP) monitoring interventions to control hypertension. Evidence acquisition The literature search from database inception to March 2015 identified 22 studies for inclusion with three types of interventions: SMBP used alone, SMBP with additional support, and SMBP within team-based care (TBC). Two formulae were used to convert reductions in systolic BP (SBP) to quality-adjusted life years (QALYs) to produce cost per QALY saved. All analyses were conducted in 2015, with estimates adjusted to 2014 U.S dollars. Evidence synthesis Median costs of intervention were $60 and $174 per person for SMBP alone and SMBP with additional support, respectively, and $732 per person per year for SMBP within TBC. SMBP alone and SMBP with additional support reduced healthcare cost per person per year from outpatient visits and medication (medians $148 and $3, respectively; median follow-up, 12–13 months). SMBP within TBC exhibited an increase in healthcare cost (median, $447 per person per year; median follow-up, 18 months). SMBP alone varied from cost saving to a maximum cost of $144,000 per QALY saved, with two studies reporting an increase in SBP. The two translated median costs per QALY saved were $2,800 and $4,000 for SMBP with additional support and $7,500 and $10,800 for SMBP within TBC. Conclusions SMBP monitoring interventions with additional support or within TBC are cost effective. Cost effectiveness of SMBP used alone could not be determined.

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Section: Discussionmentioning

confidence: 97%

Section: Evidence Acquisitionmentioning

confidence: 99%

Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review

Jacob

Chattopadhyay

Proia

et al. 2017

American Journal of Preventive Medicine

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“…For this reason, many instruments did not fully measure core attributes of the concept of team‐based care as identified in this analysis. Instead, those instruments focused more on antecedents, the effects of the antecedents, and consequences of team‐based care in this analysis (Goldberg et al., ; Helfrich et al., ; Jacob et al., ; Jesmin et al., ; Mitchell et al., ). For example, Helfrich et al.…”

Section: Resultsmentioning

confidence: 99%

Team-Based Care: A Concept Analysis

Baik

2016

Nurs Forum

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“…Finally, shortages in primary health care professionals will likely require expanding use of system approaches, collaborative relationships among health care professionals, and clinical‐community linkages to serve the greater number of adults needing new or intensified BP management and other related services. For example, team‐based models of care utilizing a diverse health care team—including nurses, nutritionists, and pharmacists—have been shown to be a cost‐effective strategy in BP management . Effective team‐based care often requires the integration of standardized hypertension treatment approaches (eg, protocols) to support communication between team members and help guide decision making, including the intensification of pharmacologic treatment .…”

Section: Discussionmentioning

confidence: 99%

Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline

Ritchey

Gillespie

Wozniak

et al. 2018

J of Clinical Hypertension

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Application of the 2017 ACC/AHA Hypertension Guideline expands the number of US adults requiring blood pressure (BP) management. The authors use 2011-2014 NHANES data to describe the population groups most affected by the new guideline, compared with the previous JNC-7 guideline, and describe the previous interaction with the health care sector among those adults recommended new or intensified pharmacologic treatment and/or lifestyle modification. The 2017 Hypertension Guideline reclassifies 32.3 million US adults as newly hypertensive and recommends BP-related treatment of 133.7 million adults, including 57.8 million with uncontrolled BP recommended to initiate or intensify pharmacologic treatment and 50.5 million newly recommended lifestyle modification alone. An estimated 13.1 million (22.7%) adults recommended to initiate or intensify pharmacologic treatment, and 20.6 million (40.8%) adults newly recommended lifestyle modification alone report not having established health care linkages. Among the adults newly recommended lifestyle modification alone, the odds of reclassification from no recommended intervention, under JNC-7, to recommended lifestyle modification alone were lower for adults with established linkages to care (aOR: 0.78 [95% CI: 0.67-0.91]) compared to those without, decreased with increasing age, were greater for men (1.72 [1.52-1.94]) compared to women and were greater for obese adults (1.23 [1.00-1.53]) compared with normal or underweight adults. Application of the 2017 Hypertension Guideline increases the number and alters the distribution of US adults in need of initiating or intensifying BP treatment. This includes identifying millions of US adults who previously had limited interaction with health care and are now recommended new or intensified pharmacologic treatment and/or lifestyle modification.

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Economics of Team-based Care in Controlling Blood Pressure

Cited by 37 publications

References 53 publications

Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review

Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review

Team-Based Care: A Concept Analysis

Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline

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