Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul;47(1):86-99.
doi: 10.1016/j.amepre.2014.03.004. Epub 2014 Jun 2.

Team-based care and improved blood pressure control: a community guide systematic review

Krista K Proia  1 , Anilkrishna B Thota  2 , Gibril J Njie  1 , Ramona K C Finnie  1 , David P Hopkins  1 , Qaiser Mukhtar  1 , Nicolaas P Pronk  3 , Donald Zeigler  4 , Thomas E Kottke  3 , Kimberly J Rask  5 , Daniel T Lackland  6 , Joy F Brooks  7 , Lynne T Braun  8 , Tonya Cooksey  1 ; Community Preventive Services Task Force
Affiliations

Team-based care and improved blood pressure control: a community guide systematic review

Krista K Proia et al. Am J Prev Med. 2014 Jul.

Abstract

Context: Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes.

Evidence acquisition: An existing systematic review (search period, January 1980-July 2003) assessing team-based care for BP control was supplemented with a Community Guide update (January 2003-May 2012). For the Community Guide update, two reviewers independently abstracted data and assessed quality of eligible studies.

Evidence synthesis: Twenty-eight studies in the prior review (1980-2003) and an additional 52 studies from the Community Guide update (2003-2012) qualified for inclusion. Results from both bodies of evidence suggest that team-based care is effective in improving BP outcomes. From the update, the proportion of patients with controlled BP improved (median increase=12 percentage points); systolic BP decreased (median reduction=5.4 mmHg); and diastolic BP also decreased (median reduction=1.8 mmHg).

Conclusions: Team-based care increased the proportion of people with controlled BP and reduced both systolic and diastolic BP, especially when pharmacists and nurses were part of the team. Findings are applicable to a range of U.S. settings and population groups. Implementation of this multidisciplinary approach will require health system-level organizational changes and could be an important element of the medical home.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Analytic framework: team-based care for improved blood pressure control DBP, diastolic blood pressure; PCP, primary care provider; SBP, systolic blood pressure
Figure 2
Figure 2
Search process ESR, existing systematic review; TBC, team-based care
Figure 3
Figure 3
Study limitations from Community Guide review (2003–2012, n=52)
Figure 4
Figure 4
Changes in proportion of patients with controlled blood pressure attributable to team-based care, Community Guide review, 2003–2012 IQI, interquartile interval; pct pts, percentage points
Figure 5
Figure 5
Changes in mean systolic blood pressure attributable to team-based care, Community Guide review, 2003–2012 IQI, interquartile interval; SBP, systolic blood pressure
See this image and copyright information in PMC

References

    1. CDC. Vital signs: prevalence, treatment, and control of hypertension —U.S., 1999–2002 and 2005–2008. MMWR Morb Mortal Wkly Rep. 2011;60(4):103–108. - PubMed
    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42(6):1206–1252. - PubMed
    1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation. 2012;125(1):e2–e220. - PMC - PubMed
    1. Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the U.S.: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4):e1000058. - PMC - PubMed
    1. CDC. Vital signs: awareness and treatment of uncontrolled hypertension among adults—U.S., 2003–2010. MMWR Morb Mortal Wkly Rep. 2012;61:703–709. - PubMed

Publication types

MeSH terms