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Barbershop Population Health Pilot Cuts Uncontrolled Hypertension

Barbershops may be able to cut blood pressure, not just hair, for black men with uncontrolled hypertension.

Population health and chronic disease management

Source: Thinkstock

By Jennifer Bresnick

- Barbers in Los Angeles helped cut their patrons’ blood pressure along with their hair in a new study aimed at reducing uncontrolled hypertension among non-Hispanic black males. 

Researchers at Cedars-Sinai Medical Center enlisted 52 black-owned barbershops in the LA area to offer blood pressure checks and pharmacist-led consultations to customers in an effort to extend chronic disease management services into the community.

Sixty-three percent of participants with uncontrolled high blood pressure who took advantage of pharmacist consultations held at the barbershop were able to lower their blood pressure to healthy levels within six months, says the study published in the New England Journal of Medicine.

In contrast, only 11.7 percent hypertensive patrons in a control group achieved the same blood pressure results. 

Members of the control group were able to have their blood pressure checked at the barbershop, but were encouraged to seek care from their usual primary care provider instead of meeting directly with the specialty-trained pharmacists.

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Non-Hispanic black men are among the most likely to experience hypertension, and many are unaware that their blood pressure is above recommended levels, says lead author Dr. Ronald Victor and his colleagues. 

Hypertension is associated with a host of additional chronic diseases and may lead to long-term health problems, yet few studies have focused on the effect of community-based interventions to address this high-risk population.

To start to close this knowledge gap, Victor and his team enrolled 319 patrons of participating barbershops with systolic blood pressure above 140mm Hg.  Recently revised hypertension guidelines state that controlled blood pressure is 130/80.

“Under these new guidelines, approximately 3.5 million more black men in the United States would be considered to have hypertension,” said the authors.

“Because currently 58.4 percent of US black men with hypertension have a blood pressure of 140/90 mm Hg or more, our intervention offers an evidence-based model for implementing these new, more stringent guidelines.”

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The study included two full-time, doctoral-level pharmacists who received additional certification as hypertension clinicians and signed a collaborative practice agreement with the participants’ primary care providers.

“In the intervention group, pharmacists met regularly with participants at the barbershops and prescribed and monitored a drug-intensification regimen and then sent notes on progress to the participants’ providers,” the study explains. 

The pharmacists also interviewed participants and posted their stories on shop walls, reviewed blood pressure trends, and gave participants $25 vouchers to offset the costs of prescribed generic drugs.

In contrast, participants in the control group received education about blood pressure, and barbers were trained to encourage follow-up with a primary care physician. Locations were cluster-randomized into control and intervention groups. 

Both groups received the results of two blood pressure screenings, follow-up recommendations, follow-up calls at 3 months, and vouchers for monthly haircuts to promote retention within the study.

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“Field interviewers administered 30-minute, in-person, computer-based questionnaires in barbershops to participants in both groups at baseline and 6 months,” the study says.

“These interviewers recorded blood pressure and structured response data on baseline characteristics, participant-reported outcomes, and prescription information transcribed from pill bottles.”

At the beginning of the study, the mean systolic blood pressure for intervention group members was 152.8 mm Hg.  For the control group, the mean was 154.6 mm Hg.

At six months, members of the intervention group saw their mean systolic pressure fall by 27.0 mm Hg, compared to 9.3 mm Hg in the control population.

Reductions in diastolic blood pressure were also significantly higher in the intervention group, with an average difference in improvement of 14.9 mm Hg.

Members of the intervention group were almost more likely to receive antihypertensive drugs, the team found.  After the study period, these individuals were also more likely to report feeling engaged and educated about their health compared to the control group.

“For a community-level trial with a traditionally difficult-to-reach, mainly low-income male population, the net intervention effect on systolic blood pressure was large,” said the researchers.

Enlisting trusted community members to provide advice and opportunities to monitor blood pressure may have contributed to the effectiveness of the intervention.

“That loyal patrons of barbershops are consistent in their visits (every 2 weeks for a decade) facilitated hypertension management in the present trial,” the team pointed out.

And “because most patrons in the present trial lived alone, we speculate that peer support at the barbershop facilitated health promotion,” they added.

Offering care in community hubs like barbershops could help to deliver important chronic disease care and population health management services to individuals that may not have established relationships with primary care providers or may not be aware of their need to control rising risks.

While the study did have some caveats due to its small scale and relatively short duration, the pilot does suggest that expanding chronic disease monitoring and management into the community could improve outreach to high-risk groups and produce meaningful improvements in their health.

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