A Collaborative Model to Improve Blood Pressure (BP) Control and Minimize Racial Disparities

Blood pressure (BP) is controlled in only 34% of patients with high BP, leading to
unnecessary strokes, myocardial infarctions and other cardiovascular events. BP control can
be improved with physician/ pharmacist collaborative management (PPCM). Our long-range goal
is to achieve excellent BP control rates using PPCM that can be implemented in private
practices in diverse communities. The objective of this application is to conduct a large
multi-center clinical trial in clinics with geographic, racial and ethnic diversity to
determine the extent to which the model is implemented. This practice-based research
network (PBRN) is unique with a large minority population and great diversity in operation
and community size. This prospective, cluster-randomized trial uses 27 clinics, matched and
randomized to the active intervention (2 groups) or a control group in 648 patients.
Following 9 months of the intervention, one intervention group will continue the
intervention following 9 months while the other will discontinue it. We will also randomize
18 patients per clinic into a passive observation group (n=486) to determine if PPCM is
implemented more broadly in the clinic. Patients in all three groups will be followed for
24 months. We will accomplish our objectives and test our central hypothesis by pursing
the following aims:

Aim 1: To determine if patients in clinics randomized to PPCM can achieve better BP control
at 9 months compared to patients in clinics randomized to the control group.

Primary Hypothesis: BP control at 9 months will be significantly greater in patients from
clinics randomized to the two PPCM BP intervention groups compared to the control group.

Aim 2: To determine if patients in clinics randomized to continuation of PPCM achieve
better long-term BP control compared to patients in clinics randomized to discontinuation of
PPCM after 9 months and to patients in control clinics.

Our innovative approach addresses critical organizational barriers and challenges existing
approaches to achieving better BP control. This study is novel because it will: 1) be the
largest study to test this model, 2) use a cluster randomized design to include many more
clinics than previously used, 3) use a diverse group of clinics with broad geographic
distribution, 4) include large numbers of patients from minority groups to assess potential
health disparities, 5) evaluate whether the effect can be sustained long-term, 6) include
standardized BP measurements rather than error-prone office BPs, 7) minimize selection bias,
and 8) evaluate a "passive observation group" to evaluate dissemination of PPCM throughout
the practice. We expect that our study will find a 6-8 mm Hg difference in systolic BP
which would lead to 20-30% fewer coronary deaths and 25-40% fewer stroke deaths if applied
across broadly across similar settings.