Pharmacist-physician collaboration improves blood pressure control. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension Management of uncontrolled hypertension in a nurse-led clinic compared with conventional care for patients with type 2 diabetes. Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework. Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial Efficacy of a brief multifactorial adherence-based intervention in reducing blood pressure: a randomized clinical trial Cluster-Randomized Trial of a Physician/Pharmacist Collaborative Model to Improve Blood Pressure Control Approach to Antihypertensive Adherence: A Feasibility Study on the Use of Student Health Coaches for Uninsured Hypertensive Adults A Randomized Trial to Improve Patient-Centered Care and Hypertension Control in Underserved Primary Care Patients A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China’s community hypertension care: study protocol for a randomized controlled trial Cardiovascular risk management and its impact on hypertension control in primary care in low-resource settings: a cluster-randomized trial. Effect of an intensive nurse-managed medical care programme on ambulatory blood pressure in hypertensive patients. Development and evaluation of a nurse-led hypertension management model: A randomized controlled trial. Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol A Randomized Controlled Trial of Team-Based Care: Impact of Physician-Pharmacist Collaboration on Uncontrolled Hypertension Patient Ability and Willingness to Participate in a Web-Based Intervention to Improve Hypertension Control An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial
OBJECTIVE To evaluate the effect of teamwork ( physician and pharmacist ) on the management of uncontrolled hypertensive patients . METHODS This is a r and omized controlled clinical trial conducted from March to November 2009 . Patients attending the Family Medicine Clinic at Jordan University Hospital , Amman , Jordan with uncontrolled hypertension were invited to participate in the study . A total of 253 patients were r and omly allocated to an intervention ( n=130 ) or control group . In the intervention group , patients were managed by a physician-pharmacist team . In the control group , patients were managed by physician(s ) only . RESULTS In the intervention group , 79.4 % of patients achieved blood pressure ( BP ) goals specified by the Joint National Committee on Prevention and Management , Detection , Evaluation , and Treatment of High Blood Pressure ( JNC VII ) compared to 65.6 % in the control group ( p=0.01 ) . Decline in systolic BP was 16.1 + /- 14.6 mm Hg in the intervention group , and 10.6 + /- 13.5 mm Hg in the control group ( p=0.002 ) . Reduction in diastolic BP was 10.5 + /- 12.9 mm Hg in the intervention group , and 7.17 + /- 13.11 mm Hg in the control group , ( p=0.04 ) . Data were presented as mean + /- st and ard deviation . CONCLUSION This study found that the physician-pharmacist collaborative approach to uncontrolled hypertension in Jordan improved the rate of BP control in hypertensive patients , and result ed in more profound decline in both systolic and diastolic BP , and this will probably reflect on better outcomes in cardiovascular diseases . Establishing pharmaceutical care managed clinic in the setting of outpatient-clinics is possible , and provides better management of patients OBJECTIVE : To assess the effect of a physician and pharmacist teamwork approach to uncontrolled hypertension in a medical resident teaching clinic , for patients who failed to meet the recommended goals of the fifth Joint National Commission on Detection , Evaluation and Treatment of High Blood Pressure . HYPOTHESIS : Physician and pharmacist teamwork can improve the rate of meeting national blood pressure goals in patients with previously uncontrolled hypertension . DESIGN : A single-blinded r and omized controlled trial lasting 6 months . SETTING : A primary care outpatient teaching clinic . PATIENTS : A sample of 95 adult hypertensive patients who failed to meet national blood pressure goals based on three consecutive visits over a 6-month period . INTERVENTION : Patients were r and omly assigned to a control arm of st and ard medical care or to an intervention arm in which a physician and pharmacist worked together as a team . MAIN RESULTS : At study completion , the percentage of patients achieving national goals due to intervention was more than double the percentage in the control arm ( 55 % vs 20 % , p < .001 ) . Systolic blood pressure declined 23 mm Hg in the intervention arm versus 11 mm Hg in the control arm ( p < .01 ) . Diastolic blood pressure declined 14 and 3 mm Hg in the intervention and control arms , respectively ( p < .001 ) . The intervention worked equally as well in men and women and demonstrated noticeable promise in a minority of mixed-ancestry Hawaiians in whom hypertension is of special concern . CONCLUSIONS : Patients who fail to achieve national blood pressure goals under st and ard outpatient medical care may benefit from a program that includes a physician and pharmacist teamwork approach OBJECTIVE To compare the effectiveness of a nurse-led hypertension clinic with conventional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS We studied 120 men and women outpatient attendees ( 61 % non-Caucasian ) with type 2 diabetes and a seated blood pressure ( BP ) > or=140/80 mmHg . All patients were being treated for hypertension , and 71 % had increased urinary albumin excretion ( UAE ) . Patients were allocated to either a nurse-led hypertension clinic or conventional primary care . The primary outcome measure was a change in systolic BP . Secondary outcome measures were total cholesterol , HDL cholesterol , total triglycerides , HbA(1c ) , UAE , serum creatinine , and changes in absolute stroke and coronary heart disease ( CHD ) risk scores . RESULTS The mean ( 95 % CI ) difference in the decrement of systolic BP was 12.6 mmHg ( 5.9 - 19.3 ) ( P = 0.000 ) in favor of the nurse-led group , whose patients were three times more likely to a reach target systolic BP < 140 mmHg compared with conventional care ( P = 0.003 ) . A significant fall in 10-year CHD ( P = 0.004 ) and stroke risk ( P = 0.000 ) scores occurred only in the nurse-led group . There were no significant differences in the reduction of diastolic BP or any of the other secondary outcome measures at 6 months . CONCLUSIONS Compared with conventional care , a nurse-led hypertension clinic is a more effective intervention for patients with type 2 diabetes and uncontrolled hypertension . A target systolic BP < 140 mmHg is more readily achieved and may be associated with significant reductions in 10-year cardiovascular disease risk scores BACKGROUND R and omized controlled trials have provided unequivocal evidence that treatment of hypertension decreases mortality and major disability from cardiovascular disease ; however , blood pressure remains inadequately treated in most affected individuals . This large gap continues despite the facts that more than 90 % of adults with hypertension have health insurance , and hypertension is the leading cause of visits to the doctor . New approaches are needed to improve hypertension care . OBJECTIVES The Electronic Communications and Home Blood Pressure Monitoring ( e-BP ) study is a three-arm r and omized controlled trial design ed to determine whether care based on the Chronic Care Model and delivered over the Internet improves hypertension care . The primary study outcomes are systolic , diastolic , and blood pressure control ; secondary outcomes are medication adherence , patient self-efficacy , satisfaction and quality of life , and healthcare utilization and costs . METHODS Hypertensive patients receiving care at Group Health medical centers are eligible if they have uncontrolled blood pressure on two screening visits and access to the Web and an e-mail address . Study participants are r and omly assigned to three intervention groups : ( a ) usual care ; ( b ) home blood pressure monitoring receipt and proficiency training on its use and the Group Health secure patient website ( with secure e-mail access to their healthcare provider , access to a shared medical record , prescription refill and other services ) ; or ( c ) this plus pharmacist care management ( collaborative care management between the patient , the pharmacist , and the patient 's physician via a secure patient website and the electronic medical record ) . CONCLUSION We will determine whether a new model of patient-centered care that leverages Web communications , self-monitoring , and collaborative care management improves hypertension control . If this model proves successful and cost-effective , similar interventions could be used to improve the care of large numbers of patients with uncontrolled hypertension Background Hypertension is one of the key factors causing cardiovascular diseases . A substantial proportion of treated hypertensive patients do not reach recommended target blood pressure values . Shared decision making ( SDM ) is to enhance the active role of patients . As until now there exists little information on the effects of SDM training in antihypertensive therapy , we tested the effect of an SDM training programme for general practitioners ( GPs ) . Our hypotheses are that this SDM training ( 1 ) enhances the participation of patients and ( 2 ) leads to an enhanced decrease in blood pressure ( BP ) values , compared to patients receiving usual care without prior SDM training for GPs . Methods The study was conducted as a cluster r and omised controlled trial ( c RCT ) with GP practice s in Southwest Germany . Each GP practice included patients with treated but uncontrolled hypertension and /or with relevant comorbidity . After baseline assessment ( T0 ) GP practice s were r and omly allocated into an intervention and a control arm . GPs of the intervention group took part in the SDM training . GPs of the control group treated their patients as usual . The intervention was blinded to the patients . Primary endpoints on patient level were ( 1 ) change of patients ’ perceived participation ( SDM-Q-9 ) and ( 2 ) change of systolic BP ( 24h-mean ) . Secondary endpoints were changes of ( 1 ) diastolic BP ( 24h-mean ) , ( 2 ) patients ’ knowledge about hypertension , ( 3 ) adherence ( MARS-D ) , and ( 4 ) cardiovascular risk score ( CVR ) . Results In total 1357 patients from 36 general practice s were screened for blood pressure control by ambulatory blood pressure monitoring ( ABPM ) . Thereof 1120 patients remained in the study because of uncontrolled ( but treated ) hypertension and /or a relevant comorbidity . At T0 the intervention group involved 17 GP practice s with 552 patients and the  control group 19 GP practice s with 568 patients . The effectiveness analysis could not demonstrate a significant or relevant effect of the SDM training on any of the endpoints . Conclusion The study hypothesis that the SDM training enhanced patients ’ perceived participation and lowered their BP could not be confirmed . Further research is needed to examine the impact of patient participation on the treatment of hypertension in primary care . Trial registration German Clinical Trials Register ( DRKS ) : Background Lowering blood pressure ( BP ) by antihypertensive ( AHT ) drugs reduces the risks of cardiovascular events , stroke , and total mortality . However , poor adherence to AHT medications reduces their effectiveness and increases the risk of adverse events . Objective To evaluate the effectiveness of a multifactorial adherence-based intervention in a primary care setting in lowering BP . Methods / design Multicenter parallel r and omized controlled trial . Thirty two nurses in 28 primary care centers of three Spanish regions . Patients aged 18–80 years , taking AHT drugs with uncontrolled BP ( n=221 ) were r and omized to a control group ( usual care ) or a multifactorial adherence-based intervention including nurse-led motivational interviews , pill reminders , family support , BP self-recording , and simplification of the dosing regimen by a pharmacist . Main outcome measures The primary outcome was 12-month blinded measure of systolic BP ( mean of three measurements ) . The secondary outcomes were 12-month diastolic BP and proportion of patients with adequately controlled BP . Results One hundred and fourteen patients were allocated to the intervention group and 109 to the control group . At 12 months , 212 ( 89 % ) participants completed the study . The systolic BP in the intervention group was 151.3 versus 153.7 in the control group ( P=0.294 ) . The diastolic BP did not differ between groups ( 83.4 versus 83.6 ) . Of the patients in the control group , 9.2 % achieved BP control versus a 15.8 % in the intervention group . The relative risk for achieving BP control was 1.72 ( 95 % confidence interval : 0.83–3.56 ) . Conclusion A multifactorial intervention based on improving adherence in patients with uncontrolled hypertension failed to find evidence of effectiveness in lowering systolic BP . Trial registration IS RCT N21229328 Background —The purpose of this study was to evaluate if a physician/pharmacist collaborative model would be implemented as determined by improved blood pressure ( BP ) control in primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control could be sustained . Methods and Results — Prospect i ve , cluster-r and omized trial of 32 primary care offices stratified and r and omized to control , 9-month intervention ( brief ) , and 24-month intervention ( sustained ) . We enrolled 625 subjects with uncontrolled hypertension ; 54 % from racial/ethnic minority groups and 50 % with diabetes mellitus or chronic kidney disease . The primary outcome of BP control at 9 months was 43 % in intervention offices ( n=401 ) compared with 34 % in the control group ( n=224 ; adjusted odds ratio , 1.57 [ 95 % confidence interval , 0.99–2.50 ] ; P=0.059 ) . The adjusted difference in mean systolic/diastolic BP between the intervention and control groups for all subjects at 9 months was −6.1/−2.9 mm Hg ( P=0.002 and P=0.005 , respectively ) , and it was −6.4/−2.9 mm Hg ( P=0.009 and P=0.044 , respectively ) in subjects from racial or ethnic minorities . BP control and mean BP were significantly improved in subjects from racial minorities in intervention offices at 18 and 24 months ( P=0.048 to P<0.001 ) compared with the control group . Conclusions —Although the results of the primary outcome ( BP control ) were negative , the key secondary end point ( mean BP ) was significantly improved in the intervention group . Thus , the findings for secondary end points suggest that team-based care using clinical pharmacists was implemented in diverse primary care offices and BP was reduced in subjects from racial minority groups . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00935077 Despite pharmacologic advances , medication non-adherence continues to challenge primary care providers in blood pressure ( BP ) management .  Medical , nursing and pharmacy students ( n = 11 ) were recruited and trained as health coaches for uninsured , hypertensive patients ( n = 25 ) of a free clinic in an uncontrolled open trial . Pre – post analysis was conducted on BP , medication adherence , frequency of home BP monitoring , and health behavior ( eg  ,  diet , exercise ) . Patient satisfaction and feasibility of a student coach model was qualitatively evaluated . In the 12 patients who completed the intervention , an increase in medication adherence as measured by the Brief Medication Question naire was observed ( P < .01 ) , with a 11mmHg reduction in systolic BP ( P = .03 ) . Qualitative data showed patient satisfaction with the intervention and other health behavior change . This feasibility study shows use of student health coaches to combat medication non-adherence in uninsured , hypertensive adults is promising BACKGROUND African Americans and persons with low socioeconomic status ( SES ) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient population s. Moreover , continuing medical education ( CME ) and patient-activation interventions have infrequently been directed to improve the processes of care for these population s. OBJECTIVE To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups . DESIGN R and omized controlled trial conducted from January 2002 through August 2005 , with patient follow-up at 3 and 12 months , in 14 urban , community-based practice s in Baltimore , Maryl and . PARTICIPANTS Forty-one primary care physicians and 279 hypertension patients . INTERVENTIONS Physician communication skills training and patient coaching by community health workers . MAIN MEASURES Physician communication behaviors ; patient ratings of physicians ’ participatory decision-making ( PDM ) , patient involvement in care ( PIC ) , reported adherence to medications ; systolic and diastolic blood pressure ( BP ) and BP control . KEY RESULTS Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline ( −0.52 vs. −0.82 , p = 0.04 ) . At 12 months , the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians ’ PDM ( β = + 6.20 vs. −5.24 , p = 0.03 ) and PIC dimensions related to doctor facilitation ( β = + 0.22 vs. −0.17 , p = 0.03 ) and information exchange ( β = + 0.32 vs. −0.22 , p = 0.005 ) . Improvements in patient adherence and BP control did not differ across groups for the overall patient sample . However , among patients with uncontrolled hypertension at baseline , non-significant reductions in systolic BP were observed among patients in all intervention groups — the patient+physician intensive ( −13.2 mmHg ) , physician intensive/patient minimal ( −10.6 mmHg ) , and the patient intensive/physician minimal ( −16.8 mmHg ) , compared to the patient+physician minimal group ( −2.0 mmHg ) . CONCLUSION Interventions that enhance physicians ’ communication skills and activate patients to participate in their care positively affect patient-centered communication , patient perceptions of engagement in care , and may improve systolic BP among urban African-American and low SES patients with uncontrolled hypertension Background Hypertension is a major risk factor for cardiovascular disease , and its control rate has remained low worldwide . Studies have found that telemonitoring blood pressure ( BP ) helped control hypertension in r and omized controlled trials . However , little is known about its effect in a structured primary care model in which primary care physicians ( PCPs ) are partnering with cardiology specialists in electronic healthcare data sharing and medical interventions . This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine tools to facilitate community hypertension control in China . Methods / design Patients with hypertension receiving care at four community healthcare centers that are academically affiliated to Shanghai Chest Hospital , Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the previous 3 months and access to mobile Internet . Study subjects are r and omly assigned to three interventional groups : ( 1 ) usual care ; ( 2 ) home-based BP telemonitor with embedded Global System for Mobile Communications ( GSM ) module and unlimited data plan , an app to access personal healthcare record and receive personalized lifestyle coaching contents , and proficiency training of their use ; or ( 3 ) this plus coordinated PCP-cardiologist care in which PCPs and cardiologists share data via a secure CareLinker website to determine interventional approaches . The primary outcome is mean change in systolic blood pressure over a 12-month period . Secondary outcomes are changes of diastolic blood pressure , HbA1C , blood lipids , and medication adherence measured by the eight-item Morisky Medication Adherence Scale . Discussion This study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that incorporates the latest telemedicine technologies will improve hypertension care . Success of the model would help streamline the present community healthcare processes and impact a greater number of patients with uncontrolled hypertension . Trial registration Clinical Trials.gov , NCT02919033 . Registered on 23 September 2016 OBJECTIVE To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-re source setting s. METHODS Two geographically distant regions in two countries ( China and Nigeria ) were selected and 10 pairs of primary care facilities in each region were r and omly selected and matched . Regions were then r and omly assigned to a control group , which received usual care , or to an intervention group , which applied the cardiovascular risk management package . Each facility enrolled 60 consecutive patients with hypertension . Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event , according to a st and ardized treatment algorithm . Systolic blood pressure change from baseline to 12 months was the primary outcome measure . FINDINGS The study included 2397 patients with baseline hypertension : 1191 in 20 intervention facilities and 1206 in 20 control facilities .  Systolic and diastolic blood pressure decreased more in intervention patients than in controls . However , at 12 months more than half of patients still had uncontrolled hypertension ( systolic blood pressure > 140 mmHg and /or diastolic blood pressure > 90 mmHg ) . Behavioural risk factors had improved among intervention patients in Nigeria but not in China . Only about 2 % of hypertensive patients required referral to the next level of care . CONCLUSION Even in low-re source setting s , hypertensive patients can be effectively assessed and managed in primary care facilities BACKGROUND Uncontrolled hypertension is a major primary healthcare problem . AIM To investigate whether blood pressure ( BP ) control in primary care could be improved by nurses taking responsibility for managing hypertensive patients . METHODS R and omized trial with two groups : usual or intensive care .  Patients diagnosed previously as hypertensive and with a systolic office BP greater than 140mmHg were r and omized to an intensive care programme managed by trained nurses or to usual care . The intensive care programme included a visit every 6 weeks to the general practitioner 's office , with st and ardized BP measurement , self-measurement training , risk factor checks and advice on BP reduction . The intervention lasted for 1 year . The primary endpoints were systolic BP obtained by 24-hour ambulatory BP monitoring after 1 year and the change compared with baseline . RESULTS Two hundred patients from 19 physicians were enrolled ( 102 in the intensive care group ) . Data on ambulatory BP were available from 140 patients .  Systolic BP declined from 134.4+/-14.0 to 126.3+/-10.4mmHg in the intensive care group and from 132.4+/-13.5 to 128.2+/-13.0mmHg in the usual care group . There was no statistically significant difference in values after 1 year ( p=0.332 ) . The reduction in systolic BP was significantly greater in the intensive care group ( 7.6 vs 3.3mmHg in the usual care group ; p=0.036 ) . Similar results were observed for diastolic BP and day- and night-time measurements . CONCLUSIONS An intensive medical care programme in the office setting managed by trained nurses can improve BP control effectively . Nurses could take more responsibility for managing hypertensive patients BACKGROUND The hypertension prevalence rate is increasing but the control rate is unsatisfactory . Nurse-led healthcare may be an effective way to improve outcomes for hypertensive patients but more evidence is required especially at the community level . OBJECTIVE This study aims to establish a nurse-led hypertension management model and to test its effectiveness at the community level . DESIGN A single-blind , r and omized controlled trial was performed in an urban community healthcare center in China . Hypertensive patients with uncontrolled blood pressure ( systolic blood pressure ≥140mmHg and /or diastolic blood pressure ≥90mmHg ) were r and omly allocated into two groups : the study group ( n=67 ) and the control  group ( n=67 ) . The nurse-led hypertension management model included four components ( delivery system design , decision support , clinical information system and self-management support ) . Patients in the control group received usual care . Patients in the study group received a 12-week period of hypertension management . The patient outcomes , which involved blood pressure , self-care behaviors , self-efficacy , quality of life and satisfaction , were assessed at three time points : the baseline , immediately after the intervention and 4 weeks after the intervention . RESULTS After the intervention , the blood pressure of patients in the study group decreased significantly compared to those in the control group , and the mean reduction of systolic/diastolic blood pressure in the study and control groups was 14.37/7.43mmHg and 5.10/2.69mmHg , respectively ( p<0.01 ) . In addition , patients in the study group had significantly greater improvement in self-care behaviors than those in the control group ( p<0.01 ) . The study group had a higher level of satisfaction with hypertensive care than the control group ( p<0.01 ) . No statistically significant difference in self-efficacy and quality of life was detected between the two groups after the intervention . CONCLUSIONS The nurse-led hypertension management model is feasible and effective in improving the outcomes of patients with uncontrolled blood pressure at the community level Background Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment , hypertension is controlled in less than one-half of United States citizens . Methods / design This r and omized controlled trial tests whether explicit financial incentives promote the translation of guideline -recommended care for hypertension into clinical practice and improve blood pressure ( BP ) control in the primary care setting . Using constrained r and omization , we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms : physician-level incentive ; group-level incentive ; combination of physician and group incentives ; and no incentives ( control ) . All participants at the hospital ( cluster ) were assigned to the same study arm . We enrolled 83 full-time primary care physicians and 42 non-physician personnel . The intervention consisted of an educational session about guideline -recommended care for hypertension , five audit and feedback reports , and five disbursements of incentive payments . Incentive payments rewarded participants for chart-documented use of guideline -recommended antihypertensive medications , BP control , and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention . To identify potential unintended consequences of the incentives , the study team interviewed study participants , as well as non-participant primary care personnel and leadership at study sites . Chart review s included data collection on quality measures not related to hypertension . To evaluate the persistence of the effect of the incentives , the study design includes a washout period . Discussion We briefly describe the rationale for the interventions being studied , as well as the major design choices . Rigorous research design s such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements . Trial Registration http://www . clinical ABSTRACT OBJECTIVE Evaluate the effectiveness of collaborative management of hypertension by primary care-pharmacist teams in community-based clinics . STUDY DESIGN A 12-month prospect i ve , single-blind , r and omized , controlled trial in the Providence Primary Care Research Network of patients with hypertension and uncontrolled blood pressure . METHODS As compared to usual primary care , intervention consisted of pharmacy practitioners participating in the active management of hypertension  in the primary care office according to established collaborative treatment protocol s. At baseline , there was no significant difference in blood pressure between groups . Primary outcome measures were the differences in mean systolic and diastolic blood pressures between arms at study end . Secondary measures included blood pressure goal attainment ( < 140/90 mmHg ) , hypertension-related knowledge , medication adherence , home blood pressure monitoring , re source utilization , quality of life , and satisfaction . RESULTS A total of 463 subjects were enrolled ( n = 233 control , n = 230 intervention ) . Subjects receiving the intervention achieved significantly lower systolic ( p = 0.007 ) and diastolic ( p = 0.002 ) blood pressures compared to control ( 137/75 mmHg vs. 143/78 mmHg ) . In addition , 62 % of intervention subjects achieved target blood pressure compared to 44 % of control subjects ( p = 0.003 ) . The intervention group received more total office visits ( 7.2 vs. 4.9 , p < 0.0001 ) , however had fewer physician visits ( 3.2 vs. 4.7 , p < 0.0001 ) compared to control . Intervention subjects were prescribed more antihypertensive medications ( 2.7 vs. 2.4 , p = 0.02 ) , but did not take more antihypertensive pills per day ( 2.4 vs. 2.5 , p = 0.87 ) . There were minimal differences between groups in hypertension-related knowledge , medication adherence , quality of life , or satisfaction . CONCLUSIONS Patients r and omized to collaborative primary care-pharmacist hypertension management achieved significantly better blood pressure control compared to usual care with no difference in quality of life or satisfaction Background Patient-shared electronic health records provide opportunities for care outside of office visits . However , those who might benefit may be unable to or choose not to use these re sources , while others might not need them . Objective Electronic Communications and Home Blood Pressure Monitoring ( e-BP ) was a r and omized trial that demonstrated that Web-based pharmacist care led to improved blood pressure ( BP ) control . During recruitment we attempted to contact all patients with hypertension from 10 clinics to determine whether they were eligible and willing to participate . We wanted to know whether particular subgroups , particularly those from vulnerable population s , were less willing to participate or unable to because they lacked computer access . Methods From 2005 to 2006 , we sent invitation letters to and attempted to recruit 9298 patients with hypertension . Eligibility to participate in the trial included access to a computer and the Internet , an email address  , and uncontrolled BP ( BP ≥ 140/90 mmHg ) . Generalized linear models within a modified Poisson regression framework were used to estimate the relative risk ( RR ) of in eligibility due to lack of computer access and of having uncontrolled BP . Results We were able to contact 95.1 % ( 8840/9298 ) of patients . Those refusing participation ( 3032/8840 , 34.3 % ) were significantly more likely ( P < .05 ) to be female , be nonwhite , have lower levels of education , and have Medicaid insurance . Among patients who answered survey questions , 22.8 % ( 1673/7354 ) did not have computer access . Older age , minority race , and lower levels of education were risk factors for lack of computer access , with education as the strongest predictor ( RR 2.63 , 95 % CI 2.30 - 3.01 for those with a high school degree compared to a college education ) . Among hypertensive patients with computer access who were willing to participate , African American race ( RR 1.22 , 95 % CI 1.06 - 1.40 ) , male sex ( RR 1.28 , 95 % CI 1.18 - 1.38 ) , and obesity ( RR 1.53 , 95 % CI 1.31 - 1.79 ) were risk factors for uncontrolled BP . Conclusion Older age , lower socioeconomic status , and lower levels of education were associated with decreased access to and willingness to participate in a Web-based intervention to improve hypertension control . Failure to ameliorate this may worsen health care disparities . Trial Registration Clinical trials.gov NCT00158639 ; http://www . clinical trials.gov/ct2/show/NCT00158639 ( Archived by WebCite at http://www.webcitation.org/5v1jnHaeo ABSTRACT BACKGROUND To appropriately manage uncontrolled hypertension , clinicians must decide whether blood pressure ( BP ) is above goal due to a need for additional medication or to medication nonadherence . Yet , clinicians are poor judges of adherence , and uncertainty about adherence may promote inertia with respect to medication modification . OBJECTIVE We aim ed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension . DESIGN This was a cluster r and omized trial . PARTICIPANTS Twenty-four primary care providers ( 12 intervention , 12 usual care ; cluster units ) and 100 patients with uncontrolled hypertension ( 65 intervention , 35 usual care ) were included in the study . INTERVENTIONS At one visit per patient , clinicians in the intervention group received a report summarizing electronically measured adherence to the BP regimen and recommended clinical actions . Clinicians in the control group did not receive a report . MAIN MEASURES The primary outcome was the proportion of visits with appropriate clinical management ( i.e. , treatment intensification among adherent patients and adherence counseling among nonadherent patients ) . Secondary outcomes included patient-rated quality of care and communication during the visit . KEY RESULTS The proportion of visits with appropriate clinical management was higher in the intervention group than the control group ( 45 out of 65 ; 69 % ) versus ( 12 out of 35 ; 34 % ; p = 0.001 ) . A higher proportion of adherent patients in the intervention group had their regimen intensified ( p = 0.01 ) , and a higher proportion of nonadherent patients in the intervention group received adherence counseling ( p = 0.005 ) . Patients in the intervention group were more likely to give their clinician high ratings on quality of care ( p = 0.05 ) , and on measures of patient-centered ( p = 0.001 ) and collaborative communication ( p = 0.02 ) . CONCLUSIONS Providing clinicians with electronically-measured antihypertensive adherence reports reduces inertia in the management of uncontrolled hypertension . Trial Registration NCT01257347 ; http:// clinical
Team-based care increased the proportion of people with controlled BP  and reduced both systolic and diastolic BP , especially when pharmacists and nurses were part of the team .
CONTEXT Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care , established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient .
Team-based care has the potential to improve the quality of hypertension management .
The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure ( BP ) outcomes .