The potency of team-based care interventions for hypertension: a meta-analysis

Abstract

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.

Figure 1

Flow diagram for reasons trials were excluded.

Figure 2

The Odds Ratio (confidence interval) that systolic blood pressure is controlled in the intervention group compared to the control group. Figure 2a displays 8 studies involving nurses, Figure 2b displays 5 studies conducted in community pharmacies and Figure 2c figure displays 9 studies involving pharmacists in primary care clinics.

Figure 2

The Odds Ratio (confidence interval) that systolic blood pressure is controlled in the intervention group compared to the control group. Figure 2a displays 8 studies involving nurses, Figure 2b displays 5 studies conducted in community pharmacies and Figure 2c figure displays 9 studies involving pharmacists in primary care clinics.

Figure 3

Funnel plot for all studies included in Figure 2