A review of 77 studies of team-based care showed that patients’ control of blood pressure improved when their care was provided by a team of health professionals—a primary care provider supported by a pharmacist, nurse, dietitian, social worker, or community health worker—rather than by a single physician.
The collected studies showed that team-based care helped increase the proportion of patients with controlled blood pressure, led to a decrease in both systolic (top number) and diastolic (bottom number) blood pressure, and improved outcomes in patients who had diabetes and elevated blood lipids.
Team members supplemented the activities of the primary care provider by providing support and sharing responsibility for hypertension care, such as medication management, patient follow-up, and helping the patient adhere to their blood pressure control plan, including monitoring blood pressure routinely, taking medications as prescribed, reducing sodium in the diet, and increasing physical activity.
The greatest improvement in blood pressure was seen when the team members could change medications independently, or with the approval of the primary care provider. Improvements were not as great when team members could only oversee taking of medication. The complete findings of the review are expected to be published in May 2013.
“Adoption of this model throughout the United States would improve blood pressure control for the 68 million American adults who have high blood pressure and reduce their risk of heart attack, stroke, and other health problems,” said Thomas R. Frieden, M.D., M.P.H., director, Centers for Disease Control and Prevention. “This analysis shows that when primary care physicians and other health care professionals with different expertise and approaches work together to support their patients, they can find the right formula for getting blood pressure under control.”
Team-based care is a central pillar of the Million Hearts initiative, launched by the Department of Health and Human Services in September 2011. Million Hearts is a national, public-private initiative of the Department of Health and Human Services to prevent 1 million heart attacks and strokes over five years.The initiative is aligned with the Healthy People 2020 goal to reduce the proportion of persons in the U.S. population with high blood pressure. Specifically, team-based care is an evidence-based model that incorporates the contributions of a variety of team members, such as pharmacists, nurses and others, working with providers and patients to support healthy behaviors and appropriate use of medications to address cardiovascular risk factors such as high blood pressure. Blood pressure control is one of 4 health behaviors targeted by the initiative—the others are Aspirin as appropriate, Cholesterol management, and Smoking cessation—to achieve the goal of preventing 1 million heart attacks and strokes by 2017.
High blood pressure was listed as a primary or contributing cause of death for approximately 336,000 Americans in 2007. If all patients with high blood pressure were treated to goal as outlined in current clinical guidelines, it is estimated that 46,000 deaths might be averted each year. Total annual costs associated with hypertension are $156 billion, including medical costs of $131 billion and lost productivity costs of $25 billion. For more information, see www.thecommunityguide.org.
The Community Preventive Services Task Force makes recommendations based on systematic reviews of scientific literature. The findings are published in the Guide to Community Preventive Services, which provides evidence-based recommendations and findings about public health interventions and policies to improve health and promote safety and is intended to serve as a resource for people who want to know what works in public health. CDC provides ongoing scientific, administrative and technical support for the Task Force.
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