番茄社区

The success of a Black barbershop hypertension intervention persisted with the addition of a telemedicine component to reduce cost and improve efficiency of the program, a pilot study showed.

Blood pressure (BP) fell from an average 155.1/84.9 mm Hg at baseline to 126.4/75.0 mm Hg after 12 months among Black men who received the new intervention, reported C. Adair Blyler, PharmD, of Cedars-Sinai Medical Center in Los Angeles.

The systolic BP difference of 28.7 mm Hg and BP control rate of 67% (targeting <130/80 mm Hg) were nearly identical to the changes seen in the famous trial testing the in-person barbershop model of hypertension management, Blyler said during an oral abstract session at at the virtual Hypertension conference hosted by the American Heart Association.

"These findings are crucial for future broad-scale implementation efforts and development of cost-effective barbershop hypertension management programs for Black men. As Black men have many CVD [cardiovascular disease] risk factors, marked BP reductions -- if sustained and initiated widely -- may reduce the high hypertension-related disability and death among Black men in the United States," she concluded.

"This study built on the incredible success of the and added telemedicine, which the COVID era has caused many of us to adopt to varying degrees for a large number of our patients," said John Bisognano, MD, PhD, of University of Rochester Medical Center in New York.

Hypertension is itself of great importance during this time, given that it is common in CV and lung disease, as well as diabetes and may make patients more susceptible to COVID-19, according to George Bakris, MD, of University of Chicago Medicine, who was not involved with the study.

In the original randomized trial, Black barbershop patrons who had uncontrolled hypertension were recruited from barbershops in Los Angeles.

The intervention arm had barbers promoting follow-up with a specialty-trained pharmacist, who met patrons monthly at the barbershops. There, they checked BP, prescribed medication, monitored electrolytes, and forwarded progress notes to primary care providers.

Controls had barbers promote follow-up with primary care providers and lifestyle modification.

Overall, the barbershop intervention addressed several barriers to care, including awareness, trust, and accessibility, according to Blyler.

"It is based on social gatherings of African-American men where there is trust and community, and family matters can be discussed," Bakris noted.

Blyler's group determined that the biggest barrier to scaling the intervention was the approximately 2 hours that pharmacists spent every day traveling between barbershops. The original trial included 52 barbershops spread across a sprawl of 450 square miles.

The present study tested telemedicine as a potential solution to the problem.

Ten Black people were recruited from the control arm of the original barbershop trial.

Their first few months were spent trying to reach BP <130/80 mm Hg working with pharmacists in the barbershop. Once at goal, the participants transitioned to teleconference meetings with the pharmacist during their usual barbershop visit. Barbershops were equipped with a webcam and microphone in a private area.

Patients averaged 6.6 visits over 12 months. One patient was ultimately excluded from the analysis due to non-adherence.

"The present in-office model for hypertension management is inefficient for most patients and providers and has resulted in overall treatment success rates that would be viewed as woefully inadequate for so many other diseases," according to Bisognano.

Electronic and video communication have staked an important place in work and personal relationships during the COVID era.

"It stands to reason that these same technologies when used by patients and providers in telemedicine can greatly improve success in treating chronic diseases, such as hypertension, where the barriers of distance, travel, weather, and physical disabilities can be minimized," Bisognano said.

"It also stands to reason that patients may be more willing to see their providers more frequently when a 15-minute visit only takes only about 20 minutes, rather than 2 hours out of their day," he added.

Even so, trust is needed for telemedicine to work, Bakris commented.

"This, naturally, was just a small pilot study, but will probably be one of many that support this trend of the future," Bisognano said.

Another pharmacist-managed telemedicine intervention had been found to work in primary care.

Comment