Applied Evidence
Turning team-based care into a winning proposition
Team-based care can go a long way toward improving patient outcomes. This review—with accompanying tips and resource lists—can help.
EVIDENCE-BASED ANSWER:
Yes, team-based care appears to lower systolic blood pressure (SBP) by 5 to 11 mm Hg and diastolic blood pressure (DBP) by 2 to 6 mm Hg in patients with hypertension and improve lipid control in patients with diabetes (strength of recommendation: C, disease-oriented outcomes).
Team-based care lowers BP in hypertensive patients
A systematic review evaluated 80 trials (total N not defined), which included randomized controlled trials (RCTs) and quasi-experimental trials, to compare blood pressure control in hypertensive patients who received team-based care with that of patients who received usual care.1
Team-based care was defined as adding new staff or changing the roles of existing staff to provide process support and share responsibility for hypertension care with a primary care provider. Examples included using staff to help with medication management, active patient follow-up, adherence, and self-management support. The mean duration of the interventions was 12 months.
The intervention group showed greater reductions in SBP (44 trials; 5.4 mm Hg; interquartile interval [IQI]=2.0-7.2) and DBP (38 trials; 1.8 mm Hg; IQI=0.7-3.2) compared with usual care.
Free medication, care involving nurses, pharmacists lead to lower BP
Another meta-analysis examined 37 RCTs (total N not provided) comparing blood pressure control in hypertensive patients who received team-based care with patients who received usual care.2 The meta-analysis divided the studies by specific types of team-based interventions and analyzed the effect of each type on blood pressure control. It also analyzed studies based on what kind of health care professionals were involved in the intervention.
The largest absolute changes in both SBP and DBP were observed with the following interventions, compared with the control group: free medication (3 trials; SBP reduction (SBPR)=−11 mm Hg; interquartile range [IQR]=−15 to −9.1; DBP reduction [DBPR]=−6.4 mm Hg; IQR=−8.7 to −3.9); pharmacist recommending medication to physician (15 trials; SBPR=−9.3 mm Hg; IQR=−15 to −5.0; DBPR=−3.6 mm Hg; IQR=−7.0 to −1.0); education about BP medications (23 trials; SBPR=−8.8 mm Hg; IQR=−12 to −4.3; DBPR=−3.6 mm Hg; IQR=−7.0 to −1.0); and pharmacist-performed intervention (22 trials; SBPR=−8.4 mm Hg; IQR=−12 to −4; DBPR=−3.3 mm Hg; IQR=−6.9 to −0.90).