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

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• Uncontrolled hypertension remains a significant global health challenge.
• Effective management strategies are crucial for preventing cardiovascular complications.
• Interprofessional team-based care (TBC) models are emerging as promising approaches.

Purpose of the Study:

• To evaluate the long-term effect of an interprofessional TBC intervention on blood pressure (BP) control.
• To compare TBC involving nurses, pharmacists, and physicians against usual care (UC) in hypertensive patients.
• To assess BP outcomes at 6 and 12 months post-intervention.

Main Methods:

• A pragmatic randomized controlled trial was conducted in Swiss ambulatory clinics and community pharmacies.
• Uncontrolled treated hypertensive patients were randomized to TBC or UC.
• The TBC group received 6 months of intensive support from nurses and pharmacists, with physician oversight for medication adjustments.

Main Results:

• At 12 months, the TBC group showed a statistically significant reduction in daytime systolic ambulatory blood pressure measurement (ABPM) of -7 mmHg compared to UC (p=0.01).
• No significant difference in diastolic ABPM was observed between groups at 12 months.
• While BP control was not significantly different at 6 months, the TBC group trended towards better systolic BP control at 12 months (p=0.07).

Conclusions:

• The interprofessional team-based care intervention demonstrated a significant long-term benefit in reducing systolic blood pressure in uncontrolled hypertensive patients.
• The TBC model, integrating nurses and pharmacists, offers a viable strategy for improving hypertension management.
• Further research may explore optimizing TBC components for enhanced diastolic BP control.