Proia Krista K, Thota Anilkrishna B, Njie Gibril J, Finnie Ramona K C, Hopkins David P, Mukhtar Qaiser, Pronk Nicolaas P, Zeigler Donald, Kottke Thomas E, Rask Kimberly J, Lackland Daniel T, Brooks Joy F, Braun Lynne T, Cooksey Tonya
Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
Community Guide Branch, Division of Epidemiology, Analysis, and Library Services, Center for Surveillance, Epidemiology, and Laboratory Services, CDC.
Am J Prev Med. 2014 Jul;47(1):86-99. doi: 10.1016/j.amepre.2014.03.004. Epub 2014 Jun 2.
Uncontrolled hypertension remains a widely prevalent cardiovascular risk factor in the U.S. team-based care, established by adding new staff or changing the roles of existing staff such as nurses and pharmacists to work with a primary care provider and the patient. Team-based care has the potential to improve the quality of hypertension management. The goal of this Community Guide systematic review was to examine the effectiveness of team-based care in improving blood pressure (BP) outcomes.
An existing systematic review (search period, January 1980-July 2003) assessing team-based care for BP control was supplemented with a Community Guide update (January 2003-May 2012). For the Community Guide update, two reviewers independently abstracted data and assessed quality of eligible studies.
Twenty-eight studies in the prior review (1980-2003) and an additional 52 studies from the Community Guide update (2003-2012) qualified for inclusion. Results from both bodies of evidence suggest that team-based care is effective in improving BP outcomes. From the update, the proportion of patients with controlled BP improved (median increase=12 percentage points); systolic BP decreased (median reduction=5.4 mmHg); and diastolic BP also decreased (median reduction=1.8 mmHg).
Team-based care increased the proportion of people with controlled BP and reduced both systolic and diastolic BP, especially when pharmacists and nurses were part of the team. Findings are applicable to a range of U.S. settings and population groups. Implementation of this multidisciplinary approach will require health system-level organizational changes and could be an important element of the medical home.
在美国，未得到控制的高血压仍然是一种广泛存在的心血管危险因素。团队式医疗通过增加新员工或改变现有员工（如护士和药剂师）的角色，使其与初级保健提供者及患者合作来开展。团队式医疗有改善高血压管理质量的潜力。本《社区指南》系统评价的目的是检验团队式医疗在改善血压（BP）结果方面的有效性。
对一项现有的系统评价（检索期为1980年1月至2003年7月）进行补充，该评价评估了团队式医疗对血压控制的作用，并结合了《社区指南》的更新内容（2003年1月至2012年5月）。对于《社区指南》的更新内容，两名评审员独立提取数据并评估合格研究的质量。
先前评价（1980 - 2003年）中的28项研究以及《社区指南》更新内容（2003 - 2012年）中的另外52项研究符合纳入标准。这两部分证据的结果均表明，团队式医疗在改善血压结果方面是有效的。从更新内容来看，血压得到控制的患者比例有所提高（中位数增加 = 12个百分点）；收缩压下降（中位数降低 = 5.4 mmHg）；舒张压也下降（中位数降低 = 1.8 mmHg）。
团队式医疗提高了血压得到控制的人群比例，降低了收缩压和舒张压，尤其是当药剂师和护士成为团队成员时。研究结果适用于美国的一系列环境和人群群体。实施这种多学科方法将需要卫生系统层面的组织变革，并且可能是医疗之家的一个重要组成部分。
