Cardiovascular Disease: Team-Based Care to Improve Blood Pressure Control

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Snapshot

Summary of Task Force Finding

The Community Preventive Services Task Force recommends team-based care 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 80 studies of team-based care organized primarily with nurses and pharmacists working in collaboration with primary care providers, patients, and other professionals. The economic evidence indicates that team-based care is cost-effective.

Intervention

Team-based care to improve blood pressure control is a health systems-level, organizational intervention that incorporates a multidisciplinary team to improve the quality of hypertension care for patients. Team-based care is established by adding new staff or changing the roles of existing staff to work with a primary care provider.

Each team includes the patient, the patient's primary care provider, and other professionals such as nurses, pharmacists, dietitians, social workers, and community health workers. Team members provide process support and share responsibilities of hypertension care to complement the activities of the primary care provider. These responsibilities include medication management; patient follow-up; and adherence and self-management support.

Team-based care interventions typically include activities to:

Facilitate communication and coordination of care support among various team members
Enhance use of evidence-based guidelines by team members
Establish regular, structured follow-up mechanisms to monitor patients' progress and schedule additional visits as needed
Actively engage patients in their own care by providing them with education about hypertension medication, adherence support (for medication and other treatments), and tools and resources for self-management (including health behavior change)

Task Force Finding and Rationale Statement

Read the full Task Force Finding and Rationale Statement [PDF - 220 kB] for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Promotional Materials

CDC Media Release:

Task Force Recommends Team-Based Care for Improving Blood Pressure Control
Developed by CDC's Division for Heart Disease and Stroke in collaboration with Prevention The Community Guide

Community Guide News:

Community Preventive Services Task Force Recommends Team-Based Care to Improve Blood Pressure Control
Developed by The Community Guide in collaboration with CDC's Division for Heart Disease and Stroke Prevention

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What the Task Force Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review published in 2006 (Walsh et al., 28 studies, search period January 1980-July 2003) combined with more recent evidence (52 studies, search period July 2003-May 2012). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention and control.

Context

Team members who most often worked with patients and primary care providers were pharmacists and nurses.
Medication management roles for team members were implemented in three different ways. Team members could:
- Change medications independent of the primary care provider
- Change medications with primary care provider approval or consultation
- Provide only adherence support and hypertension-related information, with no direct influence on prescribed medications

Summary of Results

Previous Review – Walsh et al. (search period January 1980- July 2003)

Twenty-eight studies were included in the review.

Overall, there was an increase in the proportion of patients with controlled blood pressure, defined as being less than or equal to 140/90 mmHg.
- Controlled systolic blood pressure: median increase of 21.8 percentage points (Interquartile interval [IQI]: 9.0 to 33.8, 9 studies)
- Controlled diastolic blood pressure: median increase of 17.0 percentage points (IQI: 5.7 to 24.5, 6 studies)
Systolic blood pressure decreased by a median of 9.7 mmHg (IQI: 4.2 to 14, 17 studies).
Diastolic blood pressure decreased by 4.2 mmHg (IQI: 0.2 to 6.8, 21 studies).

Community Guide Review (search period July 2003- May 2012)

Fifty-two studies were included in the review.

The proportion of patients with controlled blood pressure (less than or equal to 140/90 mmHg) increased by a median of 12.0 percentage points (IQI: 3.2 to 20.8, 33 studies).
Systolic blood pressure decreased by a median of 5.4 mmHg (IQI: 2.0 to 7.2, 44 studies).
Diastolic blood pressure decreased by 1.8 mmHg (IQI: 0.7 to 3.2, 38 studies).
In addition to improvements in blood pressure outcomes, team-based care was effective in improving other cardiovascular disease risk factors, including:
- Diabetes (HbA1c and Blood Glucose levels)
- Cholesterol (Total and LDL cholesterol)
For teams that included pharmacists, the median improvement in the proportion of patients with controlled blood pressure was considerably higher than the overall median increase.
The effectiveness of team-based care was greater when team members could change hypertensive medications independent of the primary care provider, or with primary care provider approval or consultation.

Summary of Economic Evidence

Economic evidence comes from a Community Guide economic review (31 studies, search period January 1980 – May 2012). Eleven studies provided cost-effectiveness estimates while the other studies provided estimates for the cost of intervention and the change in health care cost. All monetary values reported are in 2010 U.S. dollars.

Intervention cost of team-based care is the cost of labor and resources that complement the activities of the primary care provider by providing process support and sharing the responsibility of hypertension care.
- Median intervention cost per patient per year was $284 (IQI: $153 to $670; 29 estimates from 20 studies).
Change in health care cost includes outpatient visits, emergency department visits, hospital stays, and medications.
- Compared to usual care, the median health care cost per patient per year was $65 higher for team-based care (IQI: -$235 to $318; 23 estimates from 20 studies).
Cost effectiveness is intervention cost per quality adjusted life year (QALY) saved.
- One study directly estimated intervention cost per QALY saved to be $4763.
- Ten additional studies provided 14 estimates of the cost associated with reductions in SBP due to team-based care, and these estimates were translated to cost per QALY saved using two separate formulas.
  - Median intervention cost per QALY saved was $13,992 (IQI: $8339 to $32,292) based on one formula (Mason et al. 2005).
  - Median intervention cost per QALY saved was $9716 (IQI: $5791 to $22,425) based on the other formula (McEwan et al. 2006).

Twenty seven of 29 cost-effectiveness estimates (from 11 studies) were below the conservative threshold of $50,000 per QALY saved, which indicates that team-based care for blood pressure control is cost-effective.

Applicability

Based on the settings and populations from studies included in the Community Guide review, results are applicable to the following:

Adults and older adults
Women and men
White and African-American populations
Health care and community-based settings

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

Only a few of the included studies used large sample sizes. More studies are needed to assess the effectiveness of team-based care when it is used for large populations.
More information is needed about the effectiveness of team-based care for patients from low socioeconomic status (SES) groups and racial and ethnic groups other than Whites and African-Americans.
There were few analyses to determine the influence of factors such as race, ethnicity, income, education level and insurance status on the effectiveness of team-based care. More evidence on these factors in team-based care studies is needed.
Only a few studies evaluated teams including members besides primary care providers, nurses and pharmacists, such as community health workers and dietitians. More evidence is needed on differences in effectiveness when different types of professionals are on the team.
More information is needed about communication within teams, including how (e.g., face-to-face, telephone, e-mail, text message) and how often (e.g., weekly, monthly) patients and providers should communicate with each other.
The role of technology in facilitating team-based care needs to be examined extensively.
More information is needed about patient-centered outcomes such as satisfaction with care and adherence to healthy behaviors (e.g. increased physical activity).
Long-term studies are needed to understand the sustainability of benefits from team-based care.
Very limited information is available about reimbursement mechanisms for providers, including the role of incentives. Evidence is needed to assess the types and effectiveness of different mechanisms in use.
More information is needed to identify the primary components and drivers of intervention cost and economic benefits of team-based care. Only a few studies provided complete reporting of these components.
Several studies that reported effects on health care cost did not report the cost of the intervention. Information about both the economic benefits and the cost of intervention is necessary to determine whether the intervention provides positive net benefit.
More evidence is needed for any favorable effects on worker productivity due to team-based care. Worksite productivity effects were not considered in any study, including those implemented at worksites.
There is no standard translation of QALY saved from reduction in BP at the population level. Such a translation would be a useful approximation to long term benefits that are impractical and expensive to measure in research studies.

Study Characteristics

Limitations identified in the included studies showed significant differences in patient demographics between intervention and comparison groups at baseline, possible contamination within intervention and comparison groups, and issues related to inadequate description of populations and implemented interventions.
Thirty-eight studies were conducted in the U.S.; remaining studies were done in Europe, Canada, and Japan.
Studies were implemented solely within healthcare settings (41 studies), in community settings (9 studies), or in both a healthcare system and community setting (1 study).
Team members who collaborated with patients and primary care providers were predominantly pharmacists (15 interventions), nurses (28 interventions), or both (5 interventions).
The median duration of team-based care interventions was 12 months (IQI=6 to 12 months). Only six studies addressed team-based care interventions delivered to more than 500 patients.
Study populations included adults and older adults and were balanced across gender. For most studies, the majority of patients were either white or African American.
Eight studies focused predominantly on populations where more than 50% of participants identified as low-income. In studies providing information on education level, the majority of participants identified as having a high school education or less.

Publications

Proia KK, Thota AB, Njie GJ, et al. Team-Based Care and Improved Blood Pressure Control: A Community Guide Systematic Review. American Journal of Preventive Medicine . 2014;47(1):86–99.

Jacob V, Chattopadhyay SK, Thota AB, et al. Economics of team-based care in controlling blood pressure: a Community Guide systematic review. American Journal of Preventive Medicine. 2015;49(5):772-83.

Community Preventive Services Task Force. Team-Based Care to Improve Blood Pressure Control. Recommendation of the Community Preventive Services Task Force. American Journal of Preventive Medicine. 2014;47(1):100–2.

Sidney S. Team-based care: a step in the right direction for hypertension control. American Journal of Preventive Medicine. 2015;49(5):e81-2.

Supporting Materials

Included Studies

The Community Preventive Services Task Force recommendation on team-based care to improve blood pressure control is based on evidence from two systematic reviews.

52 studies published between 2003-2012 (Community Guide review of updated evidence)
28 studies published between 1980-2003 (Walsh J, McDonald K, Shojania K, et al. Quality improvement strategies for hypertension management: a systematic review. Medical Care 2006;44:646-57.)

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Studies from The Community Guide Updated Review (52 studies, search period 2003-2012)

Allen JK, Dennison-Himmelfarb CR, Szanton SL, Bone L, Hill MN, Levine DM, et al. Community Outreach and Cardiovascular Health (COACH) Trial: a randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. Circ Cardiovasc Qual Outcomes 2011;4(6):595-602.

Artinian NT, Flack JM, Nordstrom CK, Hockman EM, Washington OG, Jen KL, et al. Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans. Nurs Res 2007;56(5):312-22.

Becker DM, Yanek LR, Johnson WR, Jr., Garrett D, Moy TF, Reynolds SS, et al. Impact of a community-based multiple risk factor intervention on cardiovascular risk in black families with a history of premature coronary disease. Circulation 2005;111(10):1298-304.

Bogner HR, de Vries HF. Integration of depression and hypertension treatment: a pilot, randomized controlled trial. Ann Fam Med 2008;6(4):295-301.

Bosworth HB, Olsen MK, Dudley T, Orr M, Goldstein MK, Datta SK, et al. Patient education and provider decision support to control blood pressure in primary care: a cluster randomized trial. Am Heart J 2009;157(3):450-6.

Bosworth HB, Olsen MK, Grubber JM, Neary AM, Orr MM, Powers BJ, et al. Two self-management interventions to improve hypertension control: a randomized trial. Ann Intern Med 2009;151(10):687-95.

Bosworth HB, Powers BJ, Olsen MK, McCant F, Grubber J, Smith V, et al. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Arch Intern Med 2011;171(13):1173-80.

Brennan T, Spettell C, Villagra V, Ofili E, McMahill-Walraven C, Lowy EJ, et al. Disease management to promote blood pressure control among African Americans. Popul Health Manag 2010;13(2):65-72.

Bunting BA, Smith BH, Sutherland SE. The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc 2008;48(1):23-31.

Carter BL, Ardery G, Dawson JD, James PA, Bergus GR, Doucette WR, et al. Physician and pharmacist collaboration to improve blood pressure control. Arch Intern Med 2009;169(21):1996-2002.

Carter BL, Bergus GR, Dawson JD, Farris KB, Doucette WR, Chrischilles EA, et al. A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. J Clin Hypertens (Greenwich) 2008;10(4):260-71.

Chabot I, Moisan J, Gregoire JP, Milot A. Pharmacist intervention program for control of hypertension. Ann Pharmacother 2003;37(9):1186-93.

Chen EH, Thom DH, Hessler DM, Phengrasamy L, Hammer H, Saba G, et al. Using the Teamlet Model to improve chronic care in an academic primary care practice. J Gen Intern Med 2010;25 Suppl 4:S610-4.

Cohen LB, Taveira TH, Khatana SA, Dooley AG, Pirraglia PA, Wu WC. Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ 2011;37(6):801-12.

Edelman D, Fredrickson SK, Melnyk SD, Coffman CJ, Jeffreys AS, Datta S, et al. Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial. Ann Intern Med 2010;152(11):689-96.

El Fakiri F, Bruijnzeels MA, Uitewaal PJ, Frenken RA, Berg M, Hoes AW. Intensified preventive care to reduce cardiovascular risk in healthcare centres located in deprived neighbourhoods: a randomized controlled trial. Eur J Cardiovasc Prev Rehabil 2008;15(4):488-93.

Fiscella K, Volpe E, Winters P, Brown M, Idris A, Harren T. A novel approach to quality improvement in a safety-net practice: concurrent peer review visits. J Natl Med Assoc 2010;102(12):1231-6.

Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008;299(24):2857-67.

Haskell WL, Berra K, Arias E, Christopherson D, Clark A, George J, et al. Multifactor cardiovascular disease risk reduction in medically underserved, high-risk patients. Am J Cardiol 2006;98(11):1472-9.

Hennessy S, Leonard CE, Yang W, Kimmel SE, Townsend RR, Wasserstein AG, et al. Effectiveness of a two-part educational intervention to improve hypertension control: a cluster-randomized trial. Pharmacotherapy 2006;26(9):1342-7.

Hicks LS, Sequist TD, Ayanian JZ, Shaykevich S, Fairchild DG, Orav EJ, et al. Impact of computerized decision support on blood pressure management and control: a randomized controlled trial. J Gen Intern Med 2008;23(4):429-41.

Hill MN, Han HR, Dennison CR, Kim MT, Roary MC, Blumenthal RS, et al. Hypertension care and control in underserved urban African American men: behavioral and physiologic outcomes at 36 months. Am J Hypertens 2003;16(11 Pt 1):906-13.

Hunt JS, Siemienczuk J, Pape G, Rozenfeld Y, MacKay J, LeBlanc BH, et al. A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. J Gen Intern Med 2008;23(12):1966-72.

Ishani A, Greer N, Taylor BC, Kubes L, Cole P, Atwood M, et al. Effect of nurse case management compared with usual care on controlling cardiovascular risk factors in patients with diabetes: a randomized controlled trial. Diabetes Care 2011;34(8):1689-94.

Johnson W, Shaya FT, Khanna N, Warrington VO, Rose VA, Yan X, et al. The Baltimore Partnership to Educate and Achieve Control of Hypertension (The BPTEACH Trial): a randomized trial of the effect of education on improving blood pressure control in a largely African American population. J Clin Hypertens (Greenwich) 2011;13(8):563-70.

Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363(27):2611-20.

Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 2006;296(21):2563-71.

Levine DM, Bone LR, Hill MN, Stallings R, Gelber AC, Barker A, et al. The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban African-American population. Ethn Dis 2003;13(3):354-61.

Litaker D, Mion L, Planavsky L, Kippes C, Mehta N, Frolkis J. Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care. J Interprof Care 2003;17(3):223-37.

Ma J, Berra K, Haskell WL, Klieman L, Hyde S, Smith MW, et al. Case management to reduce risk of cardiovascular disease in a county health care system. Arch Intern Med 2009;169(21):1988-95.

Magid DJ, Ho PM, Olson KL, Brand DW, Welch LK, Snow KE, et al. A multimodal blood pressure control intervention in 3 healthcare systems. Am J Manag Care 2011;17(4):e96-103.

Marquez Contreras E, Vegazo Garcia O, Claros NM, Gil Guillen V, de la Figuera von Wichmann M, Casado Martinez JJ, et al. Efficacy of telephone and mail intervention in patient compliance with antihypertensive drugs in hypertension. ETECUM-HTA study.Blood Press 2005;14(3):151-8.

McLean DL, McAlister FA, Johnson JA, King KM, Makowsky MJ, Jones CA, et al. A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus: study of cardiovascular risk intervention by pharmacists-hypertension (SCRIP-HTN). Arch Intern Med 2008;168(21):2355-61.

Morgado M, Rolo S, Castelo-Branco M. Pharmacist intervention program to enhance hypertension control: a randomised controlled trial. Int J Clin Pharm 2011;33(1):132-40.

Murray MD, Harris LE, Overhage JM, Zhou XH, Eckert GJ, Smith FE, et al. Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. Pharmacotherapy 2004;24(3):324-37.

New JP, Mason JM, Freemantle N, Teasdale S, Wong L, Bruce NJ, et al. Educational outreach in diabetes to encourage practice nurses to use primary care hypertension and hyperlipidaemia guidelines (EDEN): a randomized controlled trial. Diabet Med 2004;21(6):599-603.

New JP, Mason JM, Freemantle N, Teasdale S, Wong LM, Bruce NJ, et al. Specialist nurse-led intervention to treat and control hypertension and hyperlipidemia in diabetes (SPLINT): a randomized controlled trial. Diabetes Care 2003;26(8):2250-5.

Ogedegbe G, Chaplin W, Schoenthaler A, Statman D, Berger D, Richardson T, et al. A practice-based trial of motivational interviewing and adherence in hypertensive African Americans. Am J Hypertens 2008;21(10):1137-43.

Pezzin LE, Feldman PH, Mongoven JM, McDonald MV, Gerber LM, Peng TR. Improving blood pressure control: results of home-based post-acute care interventions. J Gen Intern Med 2011;26(3):280-6.

Reid F, Murray P, Storrie M. Implementation of a pharmacist-led clinic for hypertensive patients in primary care--a pilot study. Pharm World Sci 2005;27(3):202-7.

Rinfret S, Lussier MT, Peirce A, Duhamel F, Cossette S, Lalonde L, et al. The impact of a multidisciplinary information technology-supported program on blood pressure control in primary care. Circ Cardiovasc Qual Outcomes 2009;2(3):170-7.

Rocco N, Scher K, Basberg B, Yalamanchi S, Baker-Genaw K. Patient-centered plan-of-care tool for improving clinical outcomes. Qual Manag Health Care 2011;20(2):89-97.

Rudd P, Miller NH, Kaufman J, Kraemer HC, Bandura A, Greenwald G, et al. Nurse management for hypertension. A systems approach. Am J Hypertens 2004;17(10):921-7.

Ruppar TM. Randomized pilot study of a behavioral feedback intervention to improve medication adherence in older adults with hypertension. J Cardiovasc Nurs 2010;25(6):470-9.

Simpson SH, Majumdar SR, Tsuyuki RT, Lewanczuk RZ, Spooner R, Johnson JA. Effect of adding pharmacists to primary care teams on blood pressure control in patients with type 2 diabetes: a randomized controlled trial. Diabetes Care 2011;34(1):20-6.

Svetkey LP, Pollak KI, Yancy WS, Jr., Dolor RJ, Batch BC, Samsa G, et al. Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients. Hypertension 2009;54(6):1226-33.

Tobari H, Arimoto T, Shimojo N, Yuhara K, Noda H, Yamagishi K, et al. Physician-pharmacist cooperation program for blood pressure control in patients with hypertension: a randomized-controlled trial. Am J Hypertens 2010;23(10):1144-52.

Tobe SW, Pylypchuk G, Wentworth J, Kiss A, Szalai JP, Perkins N, et al. Effect of nurse-directed hypertension treatment among First Nations people with existing hypertension and diabetes mellitus: the Diabetes Risk Evaluation and Microalbuminuria (DREAM 3) randomized controlled trial. CMAJ 2006;174(9):1267-71.

Ulm K, Huntgeburth U, Gnahn H, Briesenick C, Purner K, Middeke M. Effect of an intensive nurse-managed medical care programme on ambulatory blood pressure in hypertensive patients. Arch Cardiovasc Dis 2010;103(3):142-9.

Wakefield BJ, Holman JE, Ray A, Scherubel M, Adams MR, Hillis SL, et al. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Telemed J E Health 2011;17(4):254-61.

Wood DA, Kotseva K, Connolly S, Jennings C, Mead A, Jones J, et al. Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial. Lancet 2008;371(9629):1999-2012.

Zillich AJ. Hypertension outcomes through blood pressure monitoring and evaluation by pharmacists (HOME study). J Gen Intern Med 2005;20(12):1091.

Additional References Linked to Included Studies from The Community Guide Updated Review
(search period 2003-2012)

These additional references provide important supporting information to supplement the content available from the included studies listed above.

Bosworth HB, Olsen MK, Dudley T, Orr M, Neary A, Harrelson M, et al. The Take Control of Your Blood pressure (TCYB) study: study design and methodology. Contemp Clin Trials 2007;28(1):33-47.

Bosworth HB, Olsen MK, Gentry P, Orr M, Dudley T, McCant F, et al. Nurse administered telephone intervention for blood pressure control: a patient-tailored multifactorial intervention. Patient Educ Couns 2005;57(1):5-14.

Bosworth HB, Olsen MK, McCant F, Harrelson M, Gentry P, Rose C, et al. Hypertension Intervention Nurse Telemedicine Study (HINTS): testing a multifactorial tailored behavioral/educational and a medication management intervention for blood pressure control. Am Heart J 2007;153(6):918-24.

Cene CW, Yanek LR, Moy TF, Levine DM, Becker LC, Becker DM. Sustainability of a multiple risk factor intervention on cardiovascular disease in high-risk African American families. Ethn Dis 2008;18(2):169-75.

Datta SK, Oddone EZ, Olsen MK, Orr M, McCant F, Gentry P, et al. Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients. Am Heart J 2010;160(2):257-63.

Dennison CR, Post WS, Kim MT, Bone LR, Cohen D, Blumenthal RS, et al. Underserved urban African American men: hypertension trial outcomes and mortality during 5 years.Am J Hypertens 2007;20(2):164-71.

Dolor RJ, Yancy WS, Jr., Owen WF, Matchar DB, Samsa GP, Pollak KI, et al. Hypertension Improvement Project (HIP): study protocol and implementation challenges. Trials 2009;10:13.

Goessens BM, Visseren FL, Sol BG, de Man-van Ginkel JM, van der Graaf Y, Group SS. A randomized, controlled trial for risk factor reduction in patients with symptomatic vascular disease: the multidisciplinary Vascular Prevention by Nurses Study (VENUS).Eur J Cardiovasc Prev Rehabil 2006;13(6):996-1003.

Green BB, Anderson ML, Ralston JD, Catz S, Fishman PA, Cook AJ. Patient ability and willingness to participate in a web-based intervention to improve hypertension control. J Med Internet Res 2011;13(1):e1.

Green BB, Ralston JD, Fishman PA, Catz SL, Cook A, Carlson J, et al. Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework. Contemp Clin Trials 2008;29(3):376-95.

Ma J, Lee KV, Berra K, Stafford RS. Implementation of case management to reduce cardiovascular disease risk in the Stanford and San Mateo Heart to Heart randomized controlled trial: study protocol and baseline characteristics. Implement Sci 2006;1:21.

McLean DL, McAlister FA, Johnson JA, King DM, Jones CA, Tsuyuki RT. Improving blood pressure management in patients with diabetes: the design of the SCRIP-HTN study.Can Pharm J 2006;139(4):36-39.

Ogedegbe G, Schoenthaler A, Richardson T, Lewis L, Belue R, Espinosa E, et al. An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design. Contemp Clin Trials 2007;28(2):169-81.

Powers BJ, Olsen MK, Oddone EZ, Bosworth HB. The effect of a hypertension self-management intervention on diabetes and cholesterol control. Am J Med 2009;122(7):639-46.

Rozenfeld Y, Hunt JS. Effect of patient withdrawal on a study evaluating pharmacist management of hypertension. Pharmacotherapy 2006;26(11):1565-71.

Von Muenster SJ, Carter BL, Weber CA, Ernst ME, Milchak JL, Steffensmeier JJ, et al. Description of pharmacist interventions during physician-pharmacist co-management of hypertension. Pharm World Sci 2008;30(1):128-35.

Weber CA, Ernst ME, Sezate GS, Zheng S, Carter BL. Pharmacist-physician comanagement of hypertension and reduction in 24-hour ambulatory blood pressures.Arch Intern Med 2010;170(18):1634-9.

Wentzlaff DM, Carter BL, Ardery G, Franciscus CL, Doucette WR, Chrischilles EA, et al. Sustained blood pressure control following discontinuation of a pharmacist intervention. J Clin Hypertens (Greenwich) 2011;13(6):431-7.

Studies from Walsh et al. (28 studies, search period 1980-2003)

Five-year findings of the hypertension detection and follow-up program. II. Mortality by race-sex and age. Hypertension Detection and Follow-up Program Cooperative Group. JAMA 1979;242(23):2572-7.

Mortality after 10 1/2 years for hypertensive participants in the Multiple Risk Factor Intervention Trial. Circulation 1990;82(5):1616-28.

Artinian NT, Washington OG, Templin TN. Effects of home telemonitoring and community-based monitoring on blood pressure control in urban African Americans: a pilot study. Heart Lung 2001;30(3):191-9.

Blenkinsopp A, Blenkinsopp. Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial. Int J Pharma Pract 2011;8(3):165.

Bogden PE, Abbott RD, Williamson P, Onopa JK, Koontz LM. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. J Gen Intern Med 1998;13(11):740-5.

Borenstein JE, Graber G, Saltiel E, Wallace J, Ryu S, Archi J, et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy 2003;23(2):209-16.

Campbell NC, Ritchie LD, Thain J, Deans HG, Rawles JM, Squair JL. Secondary prevention in coronary heart disease: a randomised trial of nurse led clinics in primary care. Heart 1998;80(5):447-52.

Carter BL, Barnette DJ, Chrischilles E, Mazzotti GJ, Asali ZJ. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting.Pharmacotherapy 1997;17(6):1274-85.

Curzio JL, Rubin PC, Kennedy SS, Reid JL. A comparison of the management of hypertensive patients by nurse practitioners compared with conventional hospital care. J Hum Hypertens 1990;4(6):665-70.

Earp JA, Ory MG, Strogatz DS. The effects of family involvement and practitioner home visits on the control of hypertension. Am J Public Health 1982;72(10):1146-54.

Erfurt JC, Foote A, Heirich MA. Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization. Am J Health Promot 1991;5(6):438-48.

Erickson SR, Slaughter R, Halapy H. Pharmacists' ability to influence outcomes of hypertension therapy. Pharmacotherapy 1997;17(1):140-7.

Foote A, Erfurt JC. Hypertension control at the work site. Comparison of screening and referral alone, referral and follow-up, and on-site treatment. N Engl J Med 1983;308(14):809-13.

Garcao JA, Cabrita J. Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal. J Am Pharm Assoc (Wash) 2002;42(6):858-64.

Garcia-Pena C, Thorogood M, Armstrong B, Reyes-Frausto S, Munoz O. Pragmatic randomized trial of home visits by a nurse to elderly people with hypertension in Mexico. Int J Epidemiol 2001;30(6):1485-91.

Goldberg HI, Wagner EH, Fihn SD, Martin DP, Horowitz CR, Christensen DB, et al. A randomized controlled trial of CQI teams and academic detailing: can they alter compliance with guidelines? Jt Comm J Qual Improv 1998;24(3):130-42.

Hill MN, Bone LR, Hilton SC, Roary MC, Kelen GD, Levine DM. A clinical trial to improve high blood pressure care in young urban black men: recruitment, follow-up, and outcomes. Am J Hypertens 1999;12(6):548-54.

Hla KM, Feussner JR, Blessing-Feussner CL, Neelon FA, Linfors EW, Starmer CF, et al. BP control. Improvement in a university medical clinic by use of a physician's associate.Arch Intern Med 1983;143(5):920-3.

Krishan I, Davis CS, Nobrega FT, Smoldt RK. The Mayo three-community hypertension control program. IV. Five-year outcomes of intervention in entire communities. Mayo Clin Proc 1981;56(1):3-10.

Logan AG, Milne BJ, Achber C, Campbell WP, Haynes RB. Cost-effectiveness of a worksite hypertension treatment program. Hypertension 1981;3(2):211-8.

Logan AG, Milne BJ, Flanagan PT, Haynes RB. Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work.Hypertension 1983;5(6):828-36.

McClellan WM, Craxton LC. Improved follow-up care of hypertensive patients by a nurse practitioner in a rural clinic. J Rural Health 1985;1(2):34-41.

McGhee SM, McInnes GT, Hedley AJ, Murray TS, Reid JL. Coordinating and standardizing long-term care: evaluation of the west of Scotland shared-care scheme for hypertension. Br J Gen Pract 1994;44(387):441-5.

Mehos BM, Saseen JJ, MacLaughlin EJ. Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension.Pharmacotherapy 2000;20(11):1384-9.

Park JJ, Kelly P, Carter BL, Burgess PP. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc (Wash) 1996;NS36(7):443-51.

Schneider PJ, Larrimer JN, Visconti JA, Miller WA. Role effectiveness of a pharmacist in the maintenance of patients with hypertension and congestive heart failure. Contemp Pharm Pract 1982;5(2):74-9.

Solomon DK, Portner TS, Bass GE, Gourley DR, Gourley GA, Holt JM, et al. Clinical and economic outcomes in the hypertension and COPD arms of a multicenter outcomes study. J Am Pharm Assoc (Wash) 1998;38(5):574-85.

Vivian EM. Improving blood pressure control in a pharmacist-managed hypertension clinic. Pharmacotherapy 2002;22(12):1533-40.

Included Studies -- Economic Review (search period January 1980-May 2012)

Bertera EM, Bertera RL. The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study. Am J Public Health 1981;71(6):626-9.

Bogden PE, Abbott RD, Williamson P, Onopa JK, Koontz LM. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. J Gen Intern Med 1998;13(11):740-5.

Borenstein JE, Graber G, Saltiel E, et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy 2003;23(2):209-16.

Bosworth HB, Olsen MK, Grubber JM, et al. Two self-management interventions to improve hypertension control: a randomized trial. Ann Intern Med 2009;151(10):687-95.

Bosworth HB, Powers BJ, Olsen MK, et al. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Arch Intern Med 2011;171(13):1173-80.

Carter BL, Barnette DJ, Chrischilles E, Mazzotti GJ, Asali ZJ. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy 1997;17(6):1274-85.

Cote I, Gregoire JP, Moisan J, Chabot I, Lacroix G. A pharmacy-based health promotion programme in hypertension: cost-benefit analysis. Pharmaco Economics 2003;21(6):415-28.

Datta SK, Oddone EZ, Olsen MK, et al. Economic analysis of a tailored behavioral intervention to improve blood pressure control for primary care patients. Am Heart J 2010;160(2):257-63.

Devine EB, Hoang S, Fisk AW, Wilson-Norton JL, Lawless NM, Louie C. Strategies to optimize medication use in the physician group practice: the role of the clinical pharmacist. J Am Pharm Assoc (2003) 2009;49(2):181-91.

Eckerlund I, Jonsson E, Ryden L, Rastam L, Berglund G, Isacsson SO. Economic evaluation of a Swedish medical care program for hypertension. Health Policy 1985;5(4):299-306.

Edelman D, Fredrickson SK, Melnyk SD, et al. Medical clinics versus usual care for patients with both diabetes and hypertension: a randomized trial. Ann Intern Med 2010;152(11):689-96.

Fedder DO, Chang RJ, Curry S, Nichols G. For the patient. The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Ethn Dis 2003;13(1):146.

Forstrom MJ, Ried LD, Stergachis AS, Corliss DA. Effect of a clinical pharmacist program on the cost of hypertension treatment in an HMO family practice clinic. DICP 1990;24(3):304-9.

Isetts BJ, Schondelmeyer SW, Artz MB, et al. Clinical and economic outcomes of medication therapy management services: the Minnesota experience. J Am Pharm Assoc (2003) 2008;48(2):203-11; 3 p following 11.

Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med 2010;363(27):2611-20.

Kulchaitanaroaj P, Brooks JM, Ardery G, Newman D, Carter BL. Incremental costs associated with physician and pharmacist collaboration to improve blood pressure control. Pharmacotherapy 2012;32(8):772-80.

Logan AG, Milne BJ, Achber C, Campbell WP, Haynes RB. Cost-effectiveness of a worksite hypertension treatment program. Hypertension 1981;3(2):211-8.

Logan AG, Milne BJ, Flanagan PT, Haynes RB. Clinical effectiveness and cost-effectiveness of monitoring blood pressure of hypertensive employees at work.Hypertension 1983;5(6):828-36.

Lowey A, Moore S, Norris C, Wright D, Silcock J, Hammond P. The cost-effectiveness of pharmacist-led treatment of cardiac risk in patients with type 2 diabetes. Pharm World Sci 2007;29(5):541-5.

Ma J, Berra K, Haskell WL, et al. Case management to reduce risk of cardiovascular disease in a county health care system. Arch Intern Med 2009;169(21):1988-95.

Mason JM, Freemantle N, Gibson JM, New JP. Specialist nurse-led clinics to improve control of hypertension and hyperlipidemia in diabetes: economic analysis of the SPLINT trial. Diabetes Care 2005;28(1):40-6.

Munroe WP, Kunz K, Dalmady-Israel C, Potter L, Schonfeld WH. Economic evaluation of pharmacist involvement in disease management in a community pharmacy setting. Clin Ther 1997;19(1):113-23.

Murray MD, Harris LE, Overhage JM, et al. Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial. Pharmacotherapy 2004;24(3):324-37.

Okamoto MP, Nakahiro RK. Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic. Pharmacotherapy 2001;21(11):1337-44.

Pezzin LE, Feldman PH, Mongoven JM, McDonald MV, Gerber LM, Peng TR. Improving blood pressure control: results of home-based post-acute care interventions. J Gen Intern Med 2011;26(3):280-6.

Reed SD, Li Y, Oddone EZ, et al. Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension. Am J Hypertens 2010;23(2):142-8.

Wertz D, Hou L, DeVries A, et al. Clinical and economic outcomes of the Cincinnati Pharmacy Coaching Program for diabetes and hypertension. Manag Care 2012;21(3):44-54.

Studies Used for Economics Methods

McEwan P, Peters JR, Bergenheim K, Currie CJ. Evaluation of the costs and outcomes from changes in risk factors in type 2 diabetes using the Cardiff stochastic simulation cost-utility model (DiabForecaster). Curr Med Res Opin 2006;22(1):121-9.

Additional Materials

Search Strategies

The Community Preventive Services Task Force finding is based on evidence from a systematic review published in 2006 (Walsh et al., search period January 1980-July 2003) and a more recent Community Guide review (search period July 2003-May 2012). In updating the evidence, The Community Guide used the same search strategy that was used for the Walsh 2006 review. The following databases were searched from 1980 up to 2012 to identify studies of team-based care: MEDLINE and the Cochrane Effective Practice and Organisation of Care (EPOC) registry.

Search Terms

1.) Keywords for intervention of interest: Team-based Care

disease management/
patient care planning/
patient-centered care/
primary health care/
progressive patient care/
critical pathways/
delivery of health care, integrated/
health services accessibility/
managed care programs/
product line management/
patient care team/
patient care team/
patient-centered care/
behavior control/
counseling/
health promotion/
patient compliance/
after-hours care/
(coordination or coordinated or multifactorial or multicomponent or multidisciplinary or interdisciplinary or integrated or community-based or organized).m_titl.
(care or approach or intervention or strategy or strategies or management or managing or center* or clinic*).m_titl.
19 and 20
organization-and-administration/
or/1-18
or/21-23
total quality management/
quality control/
(tqm or cqi).m_titl.
quality.m_titl.
(continuous or total).m_titl.
28 and 29
(management or improvement).m_titl.
30 and 31
25 or 26 or 27 or 32
education, continuing/
education.m_titl.
continuing.m_titl.
35 and 36
(medical or professional* or nursing or physician* or nurse*).m_titl.
37 and 38
outreach.m_titl.
(visit* or educational).m_titl.
academic.m_titl.
detailing.m_titl.
42 and 43
41 or 44
34 or 39 or 45
diffusion of innovation/
diffusion.m_titl.
(innovation or technology).m_titl.
48 and 49
47 or 50
medical audit/
(audit or feedback or compliance or adherence or training).m_titl.
(improvement* or improving or improves or improve or guideline* or practice* or medical or provider* or physician* or nurse* or clinician* or academic or visit*).m_titl.
practice guidelines/
54 or 55
53 and 56
(financial or economic or physician*).m_titl.
patient*.mp.
58 or 59
"incentive*".m_titl.
60 and 61
reminder systems/
reminder.m_titl.
reimbursement mechanisms/
52 or 57 or 62 or 63 or 64 or 65
medical informatics/ or computer.ti. or (decision and support).ti. or telemedicine/ or telemedicine.ti. or telecommunication*.ti. or internet/ or web.ti. or modem.ti. or telephone*.ti. or telephone/
24 or 33 or 46 or 51 or 66 or 67

2.) Blood Pressure Keywords

68 and (hypertension/ or hypertension.ti. or (blood and pressure).ti.)

3.) Keywords for existing reviews

((meta-analysis.pt. or meta-analysis.tw.) or ((review.pt. or guideline.pt. or consensus.ti. or guideline*.ti. or literature.ti. or overview.ti. or review.ti. or decision support techniques/) and ((cochrane.tw. or medline.tw. or cinahl.tw. or (national.tw. and library.tw.)) or (handsearch*.tw. or search*.tw. or searching.tw.) and (hand.tw. or manual.tw. or electronic.tw. or bibliograph*.tw. or database* or (cochrane.tw. or medline.tw. or cinahl.tw. or (national.tw. and library.tw.))))) or ((synthesis.ti. or overview.ti. or review.ti. or survey.ti.) and (systematic.ti. or critical.ti. or methodologic.ti. or quantitative.ti. or qualitative.ti. or literature.ti. or evidence.ti. or evidence-based.ti.))) {No Related Terms}
meta-analysis.pt. or meta-analysis.tw.
(review or guideline).pt. or consensus.ti. or guideline*.ti. or literature.ti. or overview.ti. or review.ti. or decision support techniques/
(cochrane or medline or cinahl).tw.
(national and library).tw.
(handsearch* or search* or searching).tw
(hand or manual or electronic or bibliograph*).tw. or database*.mp.
(synthesis or overview or review or survey).ti.
(systematic or critical or methodologic or quantitative or qualitative or literature or evidence or evidence-based).ti.
71 or 72
73 or 74
79 and 80
77 and 78
73 or 74 or 76
75 and 83
72 and 80
71 or 82 or 84 or 85
71 or 81 or 82 or 84
71 or 81 or 82 or 84
86 or 87 or 88

4.) Keywords for study design

case report/
(case* or report).m_titl.
(editorial or comment or letter).pt.
90 or 91 or 92
89 not 93
(randomized or randomised or controlled or intervention* or evaluation* or impact* or effective* or study or studies or comparative feasibility or program* or design*).m_titl
(clinical trial or randomized controlled trial).pt. or epidemiologic studies/ or evaluation studies/ or comparative study/ or feasibility studies/ or intervention studies/ or program evaluation/ or epidemiologic research design/
95 or 96
94 or 97
69 and 98
limit 99 to english language

5.) Keywords for journals and authors

new-england-journal-of-medicine.jn.
jama.jn.
annals-of-internal-medicine.jn.
american-journal-of-medicine.jn.
archives-of-internal-medicine.jn.
journal-of-general-internal-medicine.jn.
bmj.jn.
lancet.jn.
canadian-medical-association-journal.jn.
clinical & investigative medicine medecine clinique et experimentale.jn.
archives-of-family-medicine.jn.
journal-of-family-practice.jn.
family-practice.jn.
annals-of-medicine.jn.
british-journal-of-general-practice.jn.
journal-of-internal-medicine.jn.
medical-journal-of-australia.jn.
southern-medical-journal.jn.
western-journal-of-medicine.jn.
"australian & new zealand journal of medicine".jn.
medical-care.jn.
health-services-research.jn.
inquiry.jn.
milbank-quarterly.jn.
health affairs.jn.
"health care financing review".jn.
"medical care research & review".jn.
effective clinical practice.jn.
evaluation & the health professions.jn.
joint commission journal on quality improvement.jn.
quality & safety in health care.jn.
international journal for quality in health care.jn.
quality in health care.jn.
qualitative health research.jn.
(reproductive and outcomes and research).jw.
(reproductive and guidelines).jw.
american-journal-of-managed-care.jn.
"american journal of medical quality".jn.
"journal of continuing education in the health professions".jn.
preventive-medicine.jn.
american-journal-of-preventive-medicine.jn.
patient education & counseling.jn.
annals-of-behavioral-medicine.jn.
journal-of-human-hypertension.jn.
hypertension.jn.
"or/116-160".jn.
or/116-160
"root (berwick d* or berlowitz d* or davidd* or kiefe c* or wagner c* or glasgow r* or boddenheimer t* or hulscher m* or grol r* or grimshaw j* or haynes b* or haynes rb or sacket d* or goldberg h* or hirschi* or nash d* or roper w* or weingarten s*".m_auts.
"root (berwick d* or berlowitz d* or davidd* or kiefe c* or wagner c* or glasgow r* or boddenheimer t* or hulscher m* or grol r* or grimshaw j* or haynes b* or haynes rb or sacket d* or goldberg h* or hirschi* or nash d* or roper w* or weingarten s*)".m_auts.
berwick d*.au.
berlowitz d*.au.
kiefe c*.au.
davis d*.au.
(wagner e* or glasgow r or boddenheimer t*).au.
(hulscher m* or grol r* or grimshaw j* or haynes b* or haynes rb* or sacket d*).au.
(sackett d* or goldberg h* or hirsch i* or nash d* or roper w* or weingarten s*).au.
or/165-171
(69 and 162) not (99 or 92)
113 and 173
115 or 174
(69 and 172) not (99 or 92)
113 and 176
175 or 177
from 178 keep 1-1106

References

Walsh JM, McDonald KM, Shojania KG, Sundaram V, Nayak S, Lewis R, et al. Quality improvement strategies for hypertension management: a systematic review. Med Care 2006;44(7):646-57.

Search Strategy -- Economic Review

The economic review is based on evidence from the Community Guide search for effectiveness evidence (search period January 1980-May 2012) and an earlier search for economic evidence conducted by CDC's Division of Heart Disease and Stroke Prevention (DHDSP) (search period January 1985 – March 2011).

The DHDSP review searched eight bibliographic databases: Medline, Embase, PsycInfo, CINAHL, EconLit, Socio Abs, Web of Science, and Cochrane. The types of documents retrieved by the search included journal articles, books, book chapters, reports, and conference papers.

Search terms and strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software.

Limits:
January 1985- March 2011
All languages
Humans (Not limited to humans in the dbs. Using Endnote, the following were eliminated: rat or rats or cattle or cow or cows or calves or chick or chicks or chicken or chickens or dog or dogs or goat or goats or pig or pigs or hamster or hamsters or horse or horses or mouse or mice or rabbit or rabbits or sheep or swine or animal or animals)

MEDLINE (2478 results)

A. Cost Effectiveness
((exp "costs and cost analysis"/ or exp health care costs/ or exp "cost of illness"/ or *economics/) and (benefit or cost$ or expenditure$ or Life years or exp Quality-Adjusted Life Years/ or "disability adjusted life years" or effectiveness)) or exp cost-benefit analysis/ or cost-effectiveness analysis or cost-utility analysis or economic evaluation

B. Hypertension
exp Hypertension/ or (hypertensi* or blood pressure* or SBP or DBP or BP).tw

EMBASE (4844 results)

A. Cost Effectiveness
((exp *"cost"/ or exp *"health care cost"/ or exp *"cost of illness"/ or *economics/) and (benefit or cost$ or expenditure$ or Life years or exp Quality Adjusted Life Year/ or "disability adjusted life years" or effectiveness)) or exp "cost benefit analysis"/ or cost-effectiveness analysis or cost-utility analysis or economic evaluation

B. Hypertension
exp Hypertension/ or (hypertensi* or blood pressure* or SBP or DBP or BP).tw

PSYCINFO (117 results)

A. Cost Effectiveness
((exp "costs and cost analysis"/ or exp health care costs/ or *economics/) and (benefit or cost$ or expenditure$ or Life years or "disability adjusted life years" or effectiveness)) or cost-benefit analys* or cost-effectiveness analysis or cost-utility analysis or economic evaluation

B. Hypertension
exp Hypertension/ or (hypertensi* or blood pressure* or SBP or DBP or BP).tw

CINAHL (123 results)

A. Cost Effectiveness
(((MH "Costs and Cost Analysis+") or (MH "Health Care Costs+") or (MH "Economic Aspects of Illness") or (MM "Economics")) and (benefit or cost* or expenditure* or Life years or (MH "Quality-Adjusted Life Years") or "disability adjusted life years" or effectiveness)) or (MH "Cost Benefit Analysis") or cost-effectiveness analysis or cost-utility analysis or economic evaluation

B. Hypertension
(MH "Hypertension+") or (hypertensi* or blood pressure* or SBP or DBP or BP)

ECONLIT (159 results)

A. Cost Effectiveness
terms not used due to the nature of the database

B. Hypertension
hypertensi* or blood pressure*

SOCIO ABS (818 results)

A. Cost Effectiveness
(DE=("costs" or "economics" or "health care costs" or "cost benefit analysis")) or cost* or economic*

B. Hypertension
DE=("blood pressure") or (hypertensi* or blood pressure* or SBP or DBP or BP)

WEB OF SCIENCE (409 results)

A. Cost Effectiveness
TS=((cost* or economic*) same (benefit or "life years" or effectiveness or utility or evaluation))

B. Hypertension
TS=(hypertensi* or "blood pressure*" or SBP or DBP or BP)

COCHRANE (1951 results)

A. Cost Effectiveness
(((MeSH descriptor Costs and Cost Analysis explode all trees) or (MeSH descriptor Economics, this term only))
and
(benefit or cost* or expenditure* or Life years or "disability adjusted life years" or effectiveness or (MeSH descriptor Quality-Adjusted Life Years explode all trees)))
or
(MeSH descriptor Cost-Benefit Analysis explode all trees) or cost-effectiveness analysis or cost-utility analysis or economic evaluation

B. Hypertension
(MeSH descriptor Hypertension explode all trees) or (hypertensi* or blood pressure* or SBP or DBP or BP)

Review References

Walsh J, McDonald K, Shojania K, et al. Quality improvement strategies for hypertension management: a systematic review. Medical Care 2006;44:646-57.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion. The Community Guide does not conduct systematic reviews of implementation.

In most U.S. health systems, successful implementation will likely require reorganization of patient care roles and responsibilities.
Health systems need to make decisions about team size, the number and type of team members, and team member roles that are best suited for their specific needs.
An important consideration is resource allocation to support providers who implement team-based care. Reimbursement mechanisms need to support key elements that sustain benefits from team-based care:
- Incentives for improving patient outcomes
- Training
- Performance feedback
- Clinical decision support systems
- Communications support
Findings suggest that programs are more effective when team members can change medication regimens using evidence-based clinical protocols, either independent of primary care providers or with their approval.
Providing patient support for participation in self-management activities is vital. Support can range from educational resources on health behavior change to community-based peer support groups. It also may rely on other forms of communication, such as mobile phones, smartphones, and patient web portals.

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