Team-Based Care and Improved Blood Pressure Control: A Community Guide Systematic Review☆
Section snippets
Context
Hypertension, defined as having systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg at two or more office visits or current use of BP-lowering medications,1, 2 remains the predominant risk factor for cardiovascular mortality in the U.S.3, 4 The prevalence of hypertension among U.S. adults (aged ≥18 years) from 2003 to 2010 was 30.4%—approximately 66.9 million adults.5 Estimated annual costs of hypertension are $93.5 billion per year1 and are projected to increase
Evidence Acquisition
Systematic review methods used by The Community Guide can be found at www.thecommunityguide.org/about/methods.html.18, 19 For this review, a coordination team was constituted, including subject matter experts on CVD from various agencies, organizations, and institutions together with qualified systematic reviewers from The Community Guide. The team worked under the oversight of the Community Preventive Services Task Force.
Evidence Synthesis
The existing systematic review by Walsh et al.17 included 28 studies published between January 1980 and July 2003. For the current Community Guide review (July 2003–May 2012), 1,628 potentially relevant titles and abstracts were found, of which 77 articles21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81,
Summary of Findings
There is strong evidence that team-based care is effective in improving BP outcomes, especially when pharmacists and nurses are part of the team. These findings are broadly applicable to various U.S. settings and population groups. Further, an independent Community Guide review99 of economic evidence indicates that team-based care for BP control is cost-effective. Implementation of this multidisciplinary team-based approach requires organizational change within the healthcare system.
Evidence Gaps
Although
Acknowledgments
The authors acknowledge Michael Schooley, David Callahan, Diane Dunet, and the Division for Heart Disease and Stroke Prevention (CDC) for their support at every step of the review. Barry Carter; Jeanette Daly (both at the University of Iowa); Kathryn MacDonald (Stanford University); and Paula Yoon (Division of Epidemiology, Analysis, and Library Services, CDC) provided guidance during the initial conceptualization. Kimberly Lane and Heba Athar (both CDC) contributed to review processes. Randy
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Names and affiliations of the Community Preventive Services Task Force members can be found at www.thecommmunityguide.org/about/task-force-members.html