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Team-based care improves BP control in hypertension
29 October 2009
MedWire News: A strategy of team-based care for patients with hypertension achieves greater reductions in blood pressure (BP) than standard intervention, results of a meta-analysis demonstrate.
Particularly notable were the contributions of pharmacists and nurses, say the researchers, who call for greater integration of these respective professions into care strategies.
Treatment of hypertension remains a key priority in the USA, and the 8th Joint National Committee on Prevention, Detection, Evaluation and Treatment of High BP (JNC-8) is currently considering strategies to improve BP control.
A number of controlled clinical trials have now examined the benefit of various strategies of interdisciplinary, team-based care.
In the present, published in the Archives of Internal Medicine, Barry Carter (University of Iowa, Iowa City, USA) and colleagues performed a search for relevant trials.
They found 37 independent studies that included at least two patient groups (one standard care and the other[s] intervention) where detailed measurements of BP were taken.
When considered separately, several interventions decreased systolic BP significantly or to a degree approaching significance, including pharmacist treatment recommendations (–9.30mmHg); providing patient education about BP medications (–8.75mmHg); intervention by nurses (–4.80mmHg); and use of a treatment algorithm (–4.00mmHg).
The likelihood of successful SBP control was also significantly increased with these measures relative to standard care, at odd ratios of 2.89 for community pharmacists, 2.17 for pharmacists within primary care clinics, and 1.69 for nursing.
Discussing their findings Carter and colleagues comment: “We believe that nurses possess unique skills in patient management and non-medication counseling techniques that pharmacists usually do not.
“Likewise, pharmacists receive 4 years of concentrated education in medication pharmacology, pharmacokinetics, pharmacodynamics, therapeutics, and chronic disease drug-therapy guidelines.”
They advise that implementation of new hypertension guidelines should consider changes in health care organizational structure to include important components of team-based care.
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