Abstract 53: Results Of The Nashville Barber-pharmacist Hypertension Management Pilot Study

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated that collaboration between barbers and pharmacists delivering hypertension management could significantly improve blood pressure as well as access to care. It is unknown if this model can be translated to other locations. This single-arm, proof-of-concept pilot study tested the development and implementation of a similar protocol in Nashville, TN (NCT04232124). Methods: Between 2019 and 2021, community stakeholders, clinicians, investigators, and the LABBPS team convened to adapt the study design and protocol. Established barbershops with barbers willing to be trained on study procedures were recruited as study sites. Non-Hispanic Black male clients, aged 35-79 years with systolic blood pressure (SBP) > 140 mmHg on two screening days were eligible for participation. Enrolled participants met with a pharmacist for lifestyle and medication management at least once monthly for a six-month period. Barbers measured blood pressure during haircuts for additional monitoring. Results: Eight barbershops in business for an average of 20 (± 5) years participated in the trial. Barbers from each shop (range: 1-4) were trained. A total of 419 clients completed screening visit 1, 82 were eligible and 52 (12%) completed visit 2. We enrolled 36, with 30 completing the initial clinical visit and 27 had complete data at 6-months. Participants were on average age 50 (± 10) years, had a body mass index 33 (± 6), 44% were currently smoking, 52% with high school or less education, and 56% reported current primary care. Baseline BP 157.7±17.1/ 95.1±13.9 mmHg improved to 125.7±11.9/75.6±9.5, a change of -32.1±21.6/ -19.5±14.1, respectively. At 6-months 85% of the group had a BP<140/90, 74% BP<135/85, and 67% BP<130/80. At baseline 15% of participants reported health as excellent/very good and this increased to 56% at 6-months (p=0.002). Adverse reactions reported were minimal. Conclusion: Implementation of the barber-pharmacist model of hypertension management and care delivery improved BP control among hypertensive Black men in Nashville. Lessons learned regarding adaptation overcoming unforeseen barriers will inform expansion into additional naïve locations for future research.

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Personalized Hypertension Management Based on Serial Assessment and Telemedicine: a Cluster Randomize Controlled Trial Protocol in Anhui, China

10.21203/rs.3.rs-47983/v1 ◽

2020 ◽

Author(s):

Siyi Xiao ◽

Xingrong Shen ◽

Rong Liu ◽

Guixian Tong ◽

Tongzhu Liu ◽

...

Keyword(s):

Blood Pressure ◽

Low Cost ◽

Controlled Trial ◽

Population Based ◽

Future Research ◽

Hypertension Management ◽

Intervention Package ◽

Self Monitoring ◽

Intervention Measures ◽

Cluster Randomized

Abstract Background: Despite tremendous investment worldwide, hypertension treatment and control rates remain low, suggesting that contemporary population-based hypertension management may have reached its efficacy ceiling. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts.Methods/design: PHMA strives to reduce hypertension harms by eight proven “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors.Discussion: PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts so comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making.Trial registration: Registered July 17, 2020. ISRCTN10999269.

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Abstract 21: Telemedicine And The Barbershop Model Of Hypertension Care For Black Men

Hypertension ◽

10.1161/hyp.76.suppl_1.21 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Ciantel A Blyler ◽

Mohamad Rashid ◽

Norma B Moy ◽

Kayslee A Kemp ◽

Florian Rader

Keyword(s):

Blood Pressure ◽

Los Angeles ◽

Black Men ◽

Medication Management ◽

Cost Effective ◽

Serious Adverse Events ◽

Blood Pressure Study ◽

Collaborative Practice Agreement ◽

The Cost

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated both efficacy and sustainability of a new model of hypertension (HTN) care for non-Hispanic black men that links health promotion by barbers to medication management by specialty-trained pharmacists. Barriers to scaling the model include logistical inefficiencies that contribute to the cost of the intervention. Most notable was the amount of time pharmacists spent traveling between barbershops. To address this, we tested whether telemedicine (remote follow-up) could be substituted for in-person visits after blood pressure (BP) control was achieved. Methods: We enrolled 10 black male patrons with systolic BP ≥ 140 mm Hg in this proof-of-concept study in which barbers promoted follow-up with pharmacists who initially met each patron in the barbershop where they prescribed BP medication under a collaborative practice agreement with the patrons’ physician. Medications were titrated during bimonthly in-person visits to achieve a BP goal of ≤130/80 mmHg. Once BP goal was reached, monthly visits were done by videoconference while barbers assisted with BP checks. Final BP and safety outcomes were assessed at 12 months. Results: After exclusion of one participant who declined adherence, 9 patients completed the intervention. Baseline BP of 155 + 14 / 83 + 11 mmHg decreased by 29 + 13 / 8.9 + 15 mmHg (p<.0001), with eight participants (89%) achieving systolic control and seven (78%) diastolic control at 12 months. These new data are statistically indistinguishable from our previous LABBPS data (p=0.8 for both change in systolic BP and diastolic BP). Overall HTN control (≤ 130/80) was 67% (6 of 9), numerically greater than the 63% observed in LABBPS (p=N.S.). As intended, the mean number of in-person pharmacist visits per patron fell from 11 in LABBPS to 6.6 visits over 12 months. No treatment-related serious adverse events occurred. Cohort retention was 90%. Conclusions: Telemedicine represents a viable substitute for in-person visits, both improving pharmacist efficiency and reducing cost while preserving intervention potency. These findings are crucial for future broad-scale implementation efforts and development of cost-effective barbershop HTN management programs for black men.

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A Pilot Study Evaluating the Effects of a Technology-Based and Positive Psychological Training Intervention on Blood Pressure in African Americans With Hypertension

Journal of Primary Care & Community Health ◽

10.1177/21501327211056186 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110561

Author(s):

Carolyn H. Still ◽

Seunghee P. Margevicius ◽

Jackson T. Wright ◽

Suebarn Ruksakulpiwat ◽

Shirley M. Moore

Keyword(s):

Blood Pressure ◽

Pilot Study ◽

African Americans ◽

Behavioral Interventions ◽

Comparison Group ◽

Medication Management ◽

Time Frame ◽

Self Management ◽

Psychological Training ◽

Experimental Group

Behavioral interventions consolidating technology are underutilized and do not reach diverse populations such as African Americans with hypertension. This pilot study aimed to evaluate the effects of a theoretically derived, technology-based intervention in African Americans with hypertension. African Americans with hypertension (N = 18; age range 25-85; 72.22% females) were randomized to the technology-based plus positive psychological training (PPT) experimental group (n = 10) or the comparison group (n = 8) for 12 weeks. The technology-based intervention included analytic components (web-based education, self-monitoring of blood pressure [BP], and medication management using a commercially free app-Medisafe) and an emotional component (comprised of skills and behaviors directed at engaging 1 in positive activities to help build increasing healthy behaviors). The comparison group received the technology-based intervention alone. Demographic information, self-management cognitive processes, self-management behaviors, and health status outcomes were assessed. After completing the 12-week intervention, the groups did not significantly differ in health outcomes, health behavior outcomes, and technology utilization outcomes. Mean systolic BP decrease 6.02 mmHg (standard deviation [SD] = 22.75) in the comparison group and 1.1 mmHg (SD = 20.64; P = .439) in the experimental group. Diastolic BP decreased 0.1 mmHg (SD = 11.78) in the comparison group and 1.5 mmHg (SD = 12.7; P = .757) in the experimental group. Our findings suggest that behavioral interventions using technology have the potential to improve self-management outcomes among African American populations. Further research is warranted in a larger sample size and a longer time frame to identify the intervention’s effectiveness.

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Do Context-Sensitive Solutions Really Work?

Transportation Research Record Journal of the Transportation Research Board ◽

10.3141/2060-12 ◽

2008 ◽

Vol 2060 (1) ◽

pp. 107-115 ◽

Cited By ~ 2

Author(s):

Lisa Olszak ◽

Robert Goldbach ◽

James Long

Keyword(s):

Information Exchange ◽

Cost Savings ◽

Interdisciplinary Approach ◽

Cost Effective ◽

Lessons Learned ◽

Future Research ◽

Project Schedule ◽

Context Sensitive ◽

Community Stakeholders ◽

Underlying Principle

Most state transportation agencies tout context-sensitive solutions (CSS) as an underlying principle in their approach to transportation project development. FHWA defines CSS as “a collaborative, interdisciplinary approach that involves all stakeholders to develop a transportation facility that fits its physical setting and preserves scenic, aesthetic, historic and environmental resources while maintaining safety and mobility.” The purpose of this research was to apply TRB CSS measurement criteria to test whether a well-planned CSS strategy contributes to a safe, cost-effective transportation project that is integrated within the fabric of the community. Olszak Management Consulting, Inc.—with support from FHWA and the Pennsylvania Turnpike Commission (PTC)—evaluated a CSS approach to an FHWA major highway project, The Mon/Fayette Expressway. PTC empowered five design advisory teams (DATs) made up of technical and community members to make decisions about critical design issues. Olszak's evaluation efforts focused on DAT stakeholder and multidisciplinary team performance activities that spanned 24 months of preliminary design. Surveys of designers, meeting facilitators, community stakeholders, and project leaders yielded strong evidence of satisfaction with both processes and outcomes. Cost savings were indicated and the project schedule was maintained. This paper details the DAT structure and functions, methods for documentation and information exchange, reliability of metrics, research findings, lessons learned, and suggestions for future research.

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Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study

Journal of Medical Internet Research ◽

10.2196/19882 ◽

2020 ◽

Vol 22 (8) ◽

pp. e19882

Author(s):

Lorraine R Buis ◽

Dana N Roberson ◽

Reema Kadri ◽

Nicole G Rockey ◽

Melissa A Plegue ◽

...

Keyword(s):

Blood Pressure ◽

Pilot Study ◽

Clinical Pharmacist ◽

Blood Pressure Monitoring ◽

Home Blood Pressure ◽

Uncontrolled Hypertension ◽

Hypertension Management ◽

Home Blood Pressure Monitoring ◽

Pressure Monitoring

Background Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8059

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Evaluating the Feasibility of Implementing an HIV Prevention Intervention for Incarcerated African American Men: Lessons Learned From a Pilot Study

Health Promotion Practice ◽

10.1177/1524839919896786 ◽

2020 ◽

Vol 21 (5) ◽

pp. 822-830

Author(s):

Carlos C. Mahaffey ◽

Danelle Stevens-Watkins ◽

A. Kathleen Burlew ◽

Myles D. Moody ◽

Paris B. Wheeler ◽

...

Keyword(s):

African American ◽

Pilot Study ◽

Hiv Prevention ◽

African American Men ◽

Setting Time ◽

Lessons Learned ◽

Future Research ◽

Prison Setting ◽

Hiv Intervention ◽

Culturally Adapted

This pilot study evaluated the feasibility of implementing an evidence-based, culturally adapted HIV intervention with substance-using African American men in a prison setting. We recruited 60, soon-to-be released African American male prisoners from a larger study ( N = 211) to be randomly selected for participation in the group-based HIV intervention, Real Men Are Safe–Culturally Adapted (REMAS-CA). Participants who were not selected for participation in the intervention received standard Centers for Disease Control and Prevention HIV prevention counseling education, provided during participant assessment in the larger study. Nearly all of the participants who were selected to participate (87%) completed the REMAS-CA intervention. To examine feasibility, data were collected about any revisions made to the HIV intervention components for the prison setting, time needed to implement the program in full, details of implementing the intervention to ensure participation and maintain retention, and participant perception of the intervention. Revisions to the intervention included reducing the number of sessions from five to three, modifying the protocol language based on the setting, and removing six activities deemed inappropriate and/or unallowable by the prison officials. The cultural considerations and intervention, overall, were well received by the participants. However, several revisions made specific to the prison and its administration could affect the potential effectiveness of the intervention. Future research is needed to determine the effectiveness of REMAS-CA among this community.

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Personalized hypertension management based on serial assessment and telemedicine (PHMA): a cluster randomize controlled trial protocol in Anhui, China

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01943-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xingrong Shen ◽

Siyi Xiao ◽

Rong Liu ◽

Guixian Tong ◽

Tongzhu Liu ◽

...

Keyword(s):

Blood Pressure ◽

Low Cost ◽

Controlled Trial ◽

Population Based ◽

Future Research ◽

Hypertension Management ◽

Intervention Package ◽

Self Monitoring ◽

Intervention Measures ◽

Cluster Randomized

Abstract Background Despite tremendous investment worldwide, hypertension treatment and control rates remain low. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts. Methods/design PHMA strives to reduce hypertension harms by eight “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors. Discussion PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making. Trial registration ISRCTN10999269. July 17, 2020; https://doi.org/10.1186/ISRCTN10999269.

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Personalized hypertension management based on serial assessment and telemedicine: a cluster randomize controlled trial protocol in Anhui, China

10.21203/rs.3.rs-50550/v1 ◽

2020 ◽

Author(s):

Siyi Xiao ◽

Xingrong Shen ◽

Rong Liu ◽

Guixian Tong ◽

Tongzhu Liu ◽

...

Keyword(s):

Blood Pressure ◽

Low Cost ◽

Controlled Trial ◽

Population Based ◽

Future Research ◽

Hypertension Management ◽

Intervention Package ◽

Self Monitoring ◽

Intervention Measures ◽

Cluster Randomized

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Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants

Ethnicity & Disease ◽

10.18865/ed.27.3.223 ◽

2017 ◽

Vol 27 (3) ◽

pp. 223 ◽

Cited By ~ 4

Author(s):

Pratik Mehta ◽

Anthony Brown ◽

Bowen Chung ◽

Felica Jones ◽

Lingqi Tang ◽

...

Keyword(s):

Mental Health ◽

Los Angeles ◽

Technical Assistance ◽

Cluster Randomized Trial ◽

Future Research ◽

Community Partners ◽

South Los Angeles ◽

Male Clients ◽

Minority Men ◽

Mental Wellness

Objective: Limited data exist on approaches to improve depression services for men in under-resourced communities. This article explores this issue using a sub-analysis of male participants in Community Partners in Care (CPIC). Design: Community partnered, cluster, randomized trial. Setting: Hollywood-Metropolitan and South Los Angeles, California. Participants: 423 adult male clients with modified depression (PHQ-8 score≥10). Interventions: Depression collaborative care implementation using community engagement and planning (CEP) across programs compared with the more-traditional individual program, technical assistance (Resources for Services, RS). Main Outcomes Measured: Depressive symptoms (PHQ-8 score), mental health-related quality of life (MHRQL), mental wellness, services utilization and settings. Results: At screening, levels of probable depression were moderate to high (17.5%- 47.1%) among men across services sectors. Intervention effects on primary outcomes (PHQ-8 score and MHRQL) did not differ. Men in CEP compared with RS had improved mental wellness (OR 1.85, 95% CI 1.00–3.42) and reduced hospitalizations (OR .40, 95% CI .16–.98), with fewer mental health specialty medication visits (IRR 0.33, 95% CI .15–.69), and a trend toward greater faith-based depression visits (IRR 2.89, 95% CI .99–8.45). Conclusions: Exploratory sub-analyses suggest that high rates of mainly minority men in under-resourced communities have high prevalence of depression. A multisector coalition approach may hold promise for improving community-prioritized outcomes, such as mental wellness and reduced hospitalizations for men, meriting further development of this approach for future research and program design.Ethn Dis. 2017;27(3):223-232; doi:10.18865/ed.27.3.223

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From Theory to Practice: Implementation of Strategies to Reduce Acute Care Visits in Patients With Cancer

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_281139 ◽

2020 ◽

pp. 85-94

Author(s):

Bobby Daly ◽

Laura C. Michaelis ◽

John D. Sprandio ◽

Jonathan T. Kapke ◽

Ravi Kishore Narra ◽

...

Keyword(s):

Acute Care ◽

Care Delivery ◽

Management Program ◽

Lessons Learned ◽

Cancer Center ◽

Future Research ◽

Community Practice ◽

Patients With Cancer ◽

Department Of Health ◽

Risk Patients

Patients with cancer frequently seek acute care as a result of complications of their disease and adverse effects of treatment. This acute care comes at high cost to the health care system and often results in suboptimal outcomes for patients and their caregivers. The Department of Health and Human Services has identified this as a gap in our care of patients with cancer and has called for quality-improvement efforts to reduce this acute care. We highlight the efforts of three centers—a community practice, an academic practice, and a cancer center—to reduce acute care for their patients. We describe the foundational principles, the practice innovation and implementation strategy, the initial results, and the lessons learned from these interventions. Each of the described interventions sought to integrate evidence-based best practices for reducing unplanned acute care. The first, a telephone triage system, led to 82% of calls being managed at home and only 2% being directed to an emergency department (ED) or hospital. The second, a 24-hour continuity clinic, led to a 26% reduction in ED utilization for patients with cancer. The third, a digital symptom monitoring and management program for high-risk patients on active treatment, led to a 17% reduction in ED presentations. There is a need for innovative care delivery models to improve the management of symptoms for patients with cancer. Future research is needed to determine the elements of these models with the greatest impact and how successful models can be scaled to other institutions.

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