The potency of team-based care interventions for hypertension: a meta-analysis.
BACKGROUND
Team-based care is the strategy that has had the greatest effect on improving blood pressure (BP). The purpose of this systematic review was to determine the potency of interventions for BP involving nurses or pharmacists.


METHODS
A MEDLINE search for controlled clinical trials that involved a nurse or pharmacist intervention was conducted. Mean reductions in systolic (S) and diastolic (D) BP were determined by 2 reviewers who independently abstracted data and classified the different intervention components.


RESULTS
Thirty-seven articles met the inclusion criteria. Education about BP medications was significantly associated with a reduction in mean BP (-8.75/-3.60 mm Hg). Other strategies that had large effect sizes on SBP include pharmacist treatment recommendations (-9.30 mm Hg), intervention by nurses (-4.80 mm Hg), and use of a treatment algorithm (-4.00 mm Hg). The odds ratios (95% confidence intervals) for controlled BP were: nurses, 1.69 (1.48-1.93); pharmacists within primary care clinics, 2.17 (1.75-2.68); and community pharmacists, 2.89 (1.83-4.55). Mean (SD) reductions in SBP were: nursing studies, 5.84 (8.05) mm Hg; pharmacists in clinics, 7.76 (7.81) mm Hg; and community pharmacists, 9.31 (5.00) mm Hg. There were no significant differences between the nursing and pharmacy studies (P > or = .19).


CONCLUSIONS
Team-based care was associated with improved BP control, and individual components of the intervention appeared to predict potency. Implementation of new hypertension guidelines should consider changes in health care organizational structure to include important components of team-based care.
Carter
Barry L
BL
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA 52242, USA. barry-carter@uiowa.edu
Rogers
Meaghan
M
Daly
Jeanette
J
Zheng
Shimin
S
James
Paul A
PA
D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000628:therapy*; D024802:Nurse's Role; D016017:Odds Ratio; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000379:methods; D010595:Pharmacists; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D012044:Regression Analysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents