Team-Based Care Led by Pharmacists or Nurses Improves Blood Pressure Control

The 8th Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure is currently considering strategies to improve the implementation of guidelines and achieve higher BP control rates. Investigators in this study conducted a systematic review of the literature to evaluate the effectiveness of team-based BP care involving pharmacists and nurses. Thirty-seven articles published between January 1970 and February 2009 fit the study criteria (89% were based on randomized controlled trials). Investigators analyzed data including: study design, setting, and type of BP intervention (e.g., supplying free BP medications, providing education about medications, and counseling about lifestyle changes). Studies were then divided into three groups to evaluate effectiveness: 1) nursing interventions, 2) pharmacist interventions delivered in community pharmacies, and 3) interventions by clinical pharmacists working within a primary care office.

Findings indicate that team-based interventions involving nurses or pharmacists were associated with significantly improved blood pressure control, with community pharmacists having the greatest impact. In addition, counseling on lifestyle modification and providing free BP medications had a significant impact on lowering systolic BP (-7.59 mm Hg and -10.80 mm Hg, respectively). Results also show that intervention strategies that provided medication education were the most effective, but this strategy cannot be evaluated on its own merit because it was usually provided with additional strategies. The authors suggest that research involving team-based care be carefully designed, reported, and interpreted to include the organizational structure in which the intervention is performed, the education and training of the intervention providers, and the individual components of that intervention so that similar interventions can be implemented within a given healthcare system.

Carter B, Rogers M, Daly J, Zheng S, and James P. The potency of team-based care interventions for hypertension. Archives of Internal Medicine October 26, 2009;169(19):1748-55.

This study was partly supported through HSR&D. Dr. Carter is part of HSR&D's Center for Research in Implementation and Innovative Strategies in Practice, Iowa City, IA.