Team-based care for improving hypertension management among outpatients (TBC-HTA): study protocol for a pragmatic randomized controlled trial

Abstract

BackgroundBlood pressure (BP) is poorly controlled among a large proportion of hypertensive outpatients. Innovative models of care are therefore needed to improve BP control. The Team-Based Care for improving Hypertension management (TBC-HTA) study aims to evaluate the effect of a team-based care (TBC) interprofessional intervention, involving nurses, community pharmacists and physicians, on BP control of hypertensive outpatients compared to usual care in routine clinical practice.Methods/designThe TBC-HTA study is a pragmatic randomized controlled study with a 6-month follow-up which tests a TBC interprofessionnal intervention conducted among uncontrolled treated hypertensive outpatients in two ambulatory clinics and among seven nearby community pharmacies in Lausanne and Geneva, Switzerland. A total of 110 patients are being recruited and randomized to TBC (TBC: N = 55) or usual care group (UC: N = 55). Patients allocated to the TBC group receive the TBC intervention conducted by an interprofessional team, involving an ambulatory clinic nurse, a community pharmacist and a physician. A nurse and a community pharmacist meet patients every 6 weeks to measure BP, to assess lifestyle, to estimate medication adherence, and to provide education to the patient about disease, treatment and lifestyle. After each visit, the nurse and pharmacist write a summary report with recommendations related to medication adherence, lifestyle, and changes in therapy. The physician then adjusts antihypertensive therapy accordingly. Patients in the UC group receive usual routine care without sessions with a nurse and a pharmacist. The primary outcome is the difference in daytime ambulatory BP between TBC and UC patients at 6-month of follow-up. Secondary outcomes include patients’ and healthcare professionals’ satisfaction with the TBC intervention and BP control at 12 months (6 months after the end of the intervention).DiscussionThis ongoing study aims to evaluate the effect of a newly developed team-based care intervention engaging different healthcare professionals on BP control in a primary care setting in Switzerland. The results will inform policymakers on implementable strategies for routine clinical practice.Trial registrationClinicalTrials.gov registration: NCT02511093. Retrospectively registered on 28 July 2015.

Knowledge and Disposal Practice of Leftover and Expired Medicine: A Cross-Sectional Study from Nursing and Pharmacy Students’ Perspectives

“…A lack of knowledge about proper disposal of unused medicine can lead to serious consequences, such as an accumulation of toxins and chemicals from the medicine into the environment, unintentional overdose, and prescription drug abuse [6]. A number of countries have established guidelines for disposing of leftover or expired medication [7][8][9][10][11][12].…”

“…The clinical benefits resulting from collaboration among health care professionals, such as pharmacists and nurses, have been proven by many studies [12,17,18]. Nurse practitioner and pharmacist consultations in family practice resulted in major improvements in the correct use of medication [5,17].…”

Fatores associados à adesão de adultos/idosos ao tratamento da hipertensão arterial na atenção básica [Factors associated with adult/elderly adherence to the treatment of arterial hypertension in primary care] [Factores asociados con la adherencia de adultos/ancianos al tratamiento de la hipertensión arterial en atención primaria]

“…Frente ao envelhecimento populacional e à dificuldade de contratação de médicos no país, abordagens para o tratamento anti-hipertensivo, envolvendo outros profissionais, podem ser estratégia promissora para melhorar o controle da HAS 5 .O cuidado em equipe é um tipo coordenado de assistência que inclui diferentes profissões da saúde, desenvolvendo ações em colaboração, respeitando cada especialidade 7 . Esse método de manejo da HAS, apoiado na equipe, foi recomendado pela Força-Tarefa de Serviços Preventivos da Comunidade dos Estados Unidos da América (EUA), sendo nova proposta, ainda em avaliação nos países europeus, portanto alvo de muitas pesquisas em todo o mundo 4 .…”

“…Influenciada por complexas interações genéticas, psicossociais e ambientais, a HAS possui como principal risco o desenvolvimento de doenças cerebrovasculares, cardíacas e renais 2 .Atinge de 30% a 45% da população global, taxa que aumenta cada vez mais 3 . Ainda que o tratamento consiga diminuir esse risco, a doença continua sendo subtratada, subdimensionada e mal controlada 4 Calcula-se que a hipertensão acarrete de 22% a 44 % da população do Brasil, ademais possui ligação direta com a idade, sendo 60% maior entre idosos 5 .Contudo, devido à característica da HAS, de início brando, podendo evoluir para quadros graves 2 , abrem-se precedentes novos estudos envolvendo distintos métodos para o controle desta. Portanto, a investigação dessas abordagens no manejo da HAS torna-se oportuna para os rumos do cuidado, a eficácia frente ao comportamento e o enfrentamento da doença.…”

Training Health Professionals to Deliver Healthy Living Medicine

“…The content and depth to which chronic disease information is integrated into a curriculum is dependent upon the specific health profession and their perceived role within an interprofessional team. [16][17][18] Currently, a late primary (i.e., multiple risk factors well established) or secondary (i.e., confirmed chronic disease diagnosis) prevention focus is the primary educational approach in the health professions. 19 In either scenario the health professional is often trained to approach their discipline from a catch up framework, with little focus on how an individual's health condition, at the time of presentation, came to be.…”