Interventions led by pharmacists, community health workers most effective at lowering BP
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Key takeaways:
- Blood pressure-lowering interventions were most effective if led by pharmacists or community health workers.
- Interventions led by each type of professional resulted in significant BP lowering.
In a meta-analysis of trials of blood pressure-lowering interventions, those led by pharmacists and community health workers resulted in more BP lowering than those led by other professionals, researchers reported.
Katherine T. Mills, PhD, MSPH, associate professor in the department of epidemiology at Tulane University School of Medicine, and colleagues conducted a meta-analysis of 100 publications with 116 comparisons of interventions to overcome barriers to BP control to determine whether the type of professional leading the intervention affected the success of the intervention. The studies included 90,474 participants. Trial durations ranged from 6 to 24 months.
The 116 comparisons were stratified according to type of professional leading the intervention: pharmacists (n = 30), nurses (n = 24), community health workers (n = 10), health educators (n = 11), multiple health care professionals (n = 17) and physicians (n = 24).
“We did a prior analysis of different studies in this area ... and we saw there was a wide range of blood pressure reductions in these studies,” Mills told Healio. “We got interested in what were the characteristics of the studies that resulted in greater blood pressure reduction.”
Differences in effectiveness
The effects on systolic BP were greatest in interventions led by pharmacists (–7.3 mm Hg; 95% CI, –9.1 to –5.6), community health workers (–7.1 mm Hg; 95% CI, –10.8 to –3.4) and health educators (–5.2 mm Hg; 95% CI, –7.8 to –2.6), Mills and colleagues found.
Mean reductions in systolic BP were –4.2 mm Hg (95% CI, –6.1 to –2.4) for interventions led by multiple health care professionals, –3 mm Hg (95% CI, –4.2 to –1.9) for interventions led by nurses and –2.4 mm Hg (95% CI, –3.4 to –1.5) for interventions led by physicians, according to the researchers.
The greatest effect on diastolic BP occurred in interventions led by pharmacists (–3.9 mm Hg; 95% CI, –5.2 to –2.5) and by community health workers (–3.7 mm Hg; 95% CI, –6.6 to –0.8), Mills and colleagues wrote.
“One great finding from this paper is that all of the health care professionals were effective,” Mills told Healio. “We saw a significant reduction for all of them. We are just seeing who [is associated with] relatively larger changes.”
When the researchers performed multivariable-adjusted pairwise comparisons, they found that pharmacist-led interventions conferred significantly greater reduction in systolic and diastolic BP compared with interventions led by multiple health care professionals, nurses and physicians; and that community health worker-led and health educator-led interventions conferred significantly greater reduction in systolic BP compared with interventions led by physicians.
Shifting the responsibility
“Physicians, nurse practitioners and nurses in primary care environments have a lot of patients back to back, and people have a lot of comorbidities to deal with in those visits, so blood pressure medication adjustment is probably not the only thing they are dealing with in a 15-minute provider visit,” Mills told Healio. “Having some responsibilities shift to other members of a care team, like pharmacists and community health workers, can allow for more time for a health care professional to interact with the patients one-on-one. For hypertension, often it requires a number of visits ... to adjust blood pressure to a target level. Pharmacists can play that role in places where they are allowed to titrate medicines. Community health workers are part of their community, so people in the community are often more likely to listen to them in terms of making lifestyle changes and adhering to medications.”
The study “speaks to evidence for the role of additional team members like pharmacists and community health workers in blood pressure control efforts,” Mills said in an interview.
For more information:
Katherine T. Mills, PhD, MSPH, can be reached at kmills4@tulane.edu.
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