About 1 in 3 adults in the United States—an estimated 68 million—have high blood pressure, also called hypertension, and only 46% have it adequately controlled. High blood pressure increases the risk for heart disease and stroke, which are at epidemic levels and are leading causes of death in the nation. If all hypertensive patients were treated sufficiently to reach the goal specified in current clinical guidelines alone, 46,000 deaths might be averted each year. Total annual costs associated with hypertension are $156 billion, including medical costs of $131 billion and lost productivity costs of $25 billion. Now a recommendation from the
Community Preventive Services Task Force (Task Force) can help health care and public health organizations and providers deliver patient care that has been proven to work for blood pressure control.
The Task Force
recommends team-based care (TBC) to improve blood pressure control on the basis of strong evidence of effectiveness in improving the proportion of patients with controlled blood pressure and in reducing systolic (SBP) and diastolic (DBP) blood pressure. Evidence was considered strong based on findings from 77 studies of team-based care organized primarily with nurses and pharmacists working in collaboration with primary care providers, patients, and other professionals.
The Task Force based their
TBC recommendation on a systematic review of all available scientific studies. With oversight from the Task Force, scientists and subject-matter experts from the Centers for Disease Control and Prevention (CDC) conducted these reviews in collaboration with a wide range of government, academic, policy, and practice-based partners.
Team-Based Care to Improve Blood Pressure Control
In the studies included in the systematic review, health care systems improved the quality of care for patients with high blood pressure by using a team of many types of health professionals working with the patient as a member of the team. TBC involved:
- Adding new staff or changing roles of existing staff to coordinate more efficiently with the primary care provider and the patient
- Forming teams that include the patient, the patient’s primary care provider and other professionals such as nurses, pharmacists, dietitians, social workers, and community health workers
- Complementing the role of the primary care provider by having the team support and share responsibilities for hypertension care, such as medication management, patient follow-up, and helping the patient adhere to their blood pressure control plan including health behavior change
Each team consisted of the patient and a primary care provider, with most adding a pharmacist, nurse or both. The estimates for improved blood pressure – both systolic (top number) and diastolic (bottom number) - were similar in the studies that added a nurse or a pharmacist. The estimated proportion of patients with controlled blood pressure was much higher when a pharmacist was added.
In four of the 28 included studies, team-based care was implemented without a nurse or a pharmacist, but with added professionals such as community health workers and dietitians. Blood pressure improvements in these studies were small, however. More research is needed to be sure whether teams that include nurses or pharmacists are actually more effective.
Team activities in the studies typically involved:
- Facilitating communication and coordination of care among various team members
- Enhancing use of evidence-based guidelines by team members
- Establishing regular, structured ways to monitor patients’ progress and schedule additional patient visits as needed
- Actively engaging patients in their own care by educating them about hypertension medication, supporting them in following their treatment plan, and providing them with self-management tools and resources, including for health behavior change
The Task Force and the Community Guide
The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, unpaid body of public health and prevention experts that provides evidence-based findings about community preventive programs, services, and policies to improve health. The Task Force bases its findings on systematic reviews of the scientific literature. With oversight from the Task Force, scientists and subject-matter experts from the Centers for Disease Control and Prevention (CDC) conduct these reviews in collaboration with a wide range of government, academic, policy, and practice-based partners. The CDC is mandated to provide administrative, research, and technical support for the Task Force.
The Community Guide is an essential resource for people who want to know what works in public health. It provides evidence-based recommendations and findings about public health interventions and policies to improve health and promote safety.
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