Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial.

Details

Serval ID
serval:BIB_39F359B3F53B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Team-Based Care for Improving Hypertension Management: A Pragmatic Randomized Controlled Trial.
Journal
Frontiers in cardiovascular medicine
Author(s)
Santschi V., Wuerzner G., Pais B., Chiolero A., Schaller P., Cloutier L., Paradis G., Burnier M.
ISSN
2297-055X (Print)
ISSN-L
2297-055X
Publication state
Published
Issued date
2021
Peer-reviewed
Oui
Volume
8
Pages
760662
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Objective: We evaluated the effect on long term blood pressure (BP) of an interprofessional team-based care (TBC) intervention, involving nurses, pharmacists, and physicians, compared to usual care. Methods: We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC or usual care (UC). In the TBC group, nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle, support medication adherence, and provide health education for 6 months. After each visit, they wrote a report to the physician who could adjust antihypertensive therapy. The outcome was the intention-to-treat difference in mean daytime ambulatory blood pressure measurement (ABPM) and control (<135/85 mmHg) at 6 and 12 months. Results: Eighty-nine patients (60 men/29 women; mean (SD) age: 61(12) year) were randomized to TBC (n = 43) or UC (n = 46). At baseline, mean (SD) BP was 144(10)/90(8) mmHg and 147(12)/87(11) mmHg in the TBC and UC groups. At 6 months, the between-groups difference in daytime systolic ABPM was-3 mmHg [95% confidence interval (CI):-10 to +4; p = 0.45]; at 12 months, this difference was-7 mmHg [95% CI:-13 to-2; p = 0.01]. At 6 months, the between-groups difference in daytime diastolic ABPM was +2 mmHg [95% CI:-1 to +6; p = 0.20]; at 12 months, this difference was-2 mmHg [95% CI:-5 to +2; 0.42]. Upon adjustment for baseline covariates including baseline BP, the between-groups differences at 6 and 12 months were maintained. At 6 months, there was no difference in BP control. At 12 months, the TBC group tended to have a better control in systolic BP (p = 0.07) but not in diastolic BP (p = 0.33). Conclusion: While there was not significant effect on BP at 6 months of follow-up, the TBC intervention can help decrease long-term systolic BP among uncontrolled hypertensive patients.
Keywords
healthcare professionals, healthcare services research, hypertension, interprofessional intervention, team-based care
Pubmed
Web of science
Open Access
Yes
Create date
26/11/2021 19:48
Last modification date
05/08/2022 6:38
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