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

Abstract

Objective: We evaluated the effect on long term blood pressure (BP) of an interprofessional team-based care (TBC) intervention, involving nurses, pharmacists, and physicians, compared to usual care.Methods: We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC or usual care (UC). In the TBC group, nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle, support medication adherence, and provide health education for 6 months. After each visit, they wrote a report to the physician who could adjust antihypertensive therapy. The outcome was the intention-to-treat difference in mean daytime ambulatory blood pressure measurement (ABPM) and control (<135/85 mmHg) at 6 and 12 months.Results: Eighty-nine patients (60 men/29 women; mean (SD) age: 61(12) year) were randomized to TBC (n = 43) or UC (n = 46). At baseline, mean (SD) BP was 144(10)/90(8) mmHg and 147(12)/87(11) mmHg in the TBC and UC groups. At 6 months, the between-groups difference in daytime systolic ABPM was−3 mmHg [95% confidence interval (CI):−10 to +4; p = 0.45]; at 12 months, this difference was−7 mmHg [95% CI:−13 to−2; p = 0.01]. At 6 months, the between-groups difference in daytime diastolic ABPM was +2 mmHg [95% CI:−1 to +6; p = 0.20]; at 12 months, this difference was−2 mmHg [95% CI:−5 to +2; 0.42]. Upon adjustment for baseline covariates including baseline BP, the between-groups differences at 6 and 12 months were maintained. At 6 months, there was no difference in BP control. At 12 months, the TBC group tended to have a better control in systolic BP (p = 0.07) but not in diastolic BP (p = 0.33).Conclusion: While there was not significant effect on BP at 6 months of follow-up, the TBC intervention can help decrease long-term systolic BP among uncontrolled hypertensive patients.

Editorial: Women in hypertension

“…Practice guidelines are available for the management of hypertension, indicating the most effective drugs, therapeutic associations, and lifestyle modifications (14-15) to prevent cardiovascular events and reduce mortality, but many patients with hypertension remain uncontrolled. This could be partly due to diagnostic and treatment initiation inertia (16) and the type of intervention and clinical approach (17). Novel therapeutic targets have been identified using pre-clinical models of hypertension but most failed in clinical trials or generated contrasting results, possibly due to defects in patient enrollment and comorbidities, as it occurs with Vitamin D supplementation (18-21).…”

Pharmacist interventions to improve hypertension management: protocol for a systematic review of randomised controlled trials

“…Hence, we have recently shown in a trial conducted in Switzerland that an effect on BP was seen 6 months after the end of a 6 months team-based care intervention involving pharmacists. 18 This is one major element to assess the long-term effect of this type of interventions.…”

Perspectives of Pharmacists, Doctors, and Nurses on Collaborative Management of Hypertension in Primary Health Centers

“…Hypertension is a chronic disease that is treated in Primary Health Centers. The treatment of patients with hypertension requires collaboration between team members, consisting of doctors, nurses, and pharmacists (Santschi et al, 2021). Collaboration within a team requires mutual trust, mutual knowledge, having the same goals, and working together to achieve common goals (Viani et al, 2021).…”

“…The involvement of pharmacists in team collaboration can improve patients' clinical, economic, and social outcomes for patients (Shrestha et al, 2022). According to various studies, the involvement of pharmacists in team collaboration can clinically reduce systolic and diastolic blood pressure (Hirsch et al, 2015, Smith et al, 2017, Margolis et al, 2020, improve blood pressure control (Santschi et al, 2021, Njonkou et al, 2021, Mulrooney et al, 2021, increase adherence to long-term therapy (Taylor et al, 2018) and reduce unplanned visits to primary care settings (Barreto et al, 2022). From an economic perspective, it has been shown to produce cost-effective care (Kulchaitanaroaj et al, 2017, Robins et al, 2013, Chung et al, 2020.…”