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Group: Team-based care works best against hypertension

Tuesday May 15, 2012
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The Community Preventive Services Task Force on May 15 announced a recommendation of team-based care for improving blood pressure control, citing strong evidence of effectiveness.

A review of 77 studies of team-based care showed patientsí control of blood pressure improved when their care was provided by a team of health professionals rather than by a single physician. In most cases, the team consisted of a primary care provider and a nurse, pharmacist or both. In some cases, a dietitian, social worker or community health worker was included.

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 and diastolic blood pressure and improved outcomes in patients with diabetes and elevated blood lipids.

Team members supplemented the activities of the primary care provider by providing support and sharing responsibility for helping patients adhere to their blood pressure control plans through steps such as monitoring blood pressure routinely, taking medications as prescribed, reducing sodium in their diets and increasing physical activity.

The authors of the review found the greatest improvement in blood pressure when the care team members could change medications independently or with the approval of the primary care provider. Improvements were not as substantial when team members only oversaw medication intake.

"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," Thomas R. Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, said in a news release.

As CDC director, Frieden appoints the members of the Community Preventive Services Task Force, an independent, nonfederal, uncompensated body of public health and prevention experts.

"This analysis shows that when primary care physicians and other healthcare professionals with different expertise and approaches work together to support their patients, they can find the right formula for getting blood pressure under control," Frieden added.

Team-based care is a central pillar of the Million Hearts initiative, launched by the Department of Health and Human Services in September 2011 as a public-private partnership to prevent 1 million cases of myocardial infarction or stroke over five years.

Team-based care, an evidence-based model, incorporates the contributions of a variety of team members working with providers and patients to support healthy behaviors and appropriate use of medications to address cardiovascular risk factors such as hypertension. Blood pressure control is one of four health behaviors targeted by the Million Hearts initiative (http://millionhearts.hhs.gov/index.html), along with encouraging appropriate aspirin use, cholesterol management and smoking cessation.

Hypertension was listed as a primary or contributing cause of death for approximately 336,000 Americans in 2007. If all patients with hypertension were treated to goal as outlined in current clinical guidelines, an estimated 46,000 deaths could be averted each year, according to HHS. Total annual costs associated with hypertension are $156 billion, including medical costs of $131 billion and lost productivity costs of $25 billion.

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.

For more information on the latest study, visit http://bit.ly/J6w8vq.

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