New York University School of Global Public Health, New York, NY, USA.
NYU Grossman School of Medicine, New York, NY, USA.
BMC Health Serv Res. 2023 May 31;23(1):560. doi: 10.1186/s12913-023-09533-1.
There are well-established guidelines for treating hypertension (HTN), yet only half of patients with HTN meet the defined target of < 140/90. Team-based care (TBC) is an evidence-based strategy for improving blood pressure (BP) management and control. TBC is defined as the provision of health services by at least two health professionals "who work collaboratively with patients and their caregivers to accomplish shared goals to achieve coordinated, high-quality care". However, primary care practices experience challenges to implementing TBC principles and care processes; these are more pronounced in small independent practice settings (SIPs). Practice facilitation (PF) is an implementation strategy that may overcome barriers to adopting evidence-based TBC to improve HTN management in SIPs.
Using a stepped wedge randomized controlled trial design, we will test the effect of PF on the adoption of TBC to improve HTN management in small practices (< 5 FTE clinicians) in New York City, and the impact on BP control compared with usual care. We will enroll 90 SIPs and randomize them into one of three 12-month intervention waves. Practice facilitators will support SIPs to adopt TBC principles to improve implementation of five HTN management strategies (i.e., panel management, population health, measuring BP, supporting medication adherence, self-management). The primary outcome is the adoption of TBC for HTN management measured at baseline and 12 months. Secondary outcomes include the rate of BP control and sustainability of TBC and BP outcomes at 18 months. Aggregated data on BP measures are collected every 6 months in all clusters so that each cluster provides data points in both the control and intervention conditions. Using a mixed methods approach, we will also explore factors that influence the effectiveness of PF at the organization and team level.
This study will provide much-needed guidance on how to optimize adoption and sustainability of TBC in independent primary care settings to reduce the burden of disease related to suboptimal BP control and advance understanding of how facilitation works to improve implementation of evidence-based interventions.
ClinicalTrials.gov; NCT05413252 .
尽管已有治疗高血压（HTN）的既定指南，但只有一半的 HTN 患者达到了定义的<140/90 的目标。团队式医疗（TBC）是一种提高血压（BP）管理和控制的循证策略。TBC 被定义为至少由两名卫生专业人员提供的卫生服务，“他们与患者及其护理人员合作，共同实现目标，以提供协调、高质量的护理”。然而，基层医疗实践在实施 TBC 原则和护理流程方面面临挑战；在小型独立实践环境（SIP）中，这些挑战更为明显。实践促进（PF）是一种实施策略，它可能克服采用循证 TBC 以改善 SIP 中 HTN 管理的障碍。
我们将使用阶梯式楔形随机对照试验设计，测试 PF 对 TBC 采用的影响，以改善纽约市小型实践（<5 名 FTE 临床医生）中 HTN 的管理，并与常规护理相比，评估其对 BP 控制的影响。我们将招募 90 个 SIP 并将其随机分为三个为期 12 个月的干预波。实践促进者将支持 SIP 采用 TBC 原则，以改善五项 HTN 管理策略的实施（即，小组管理、人群健康、测量 BP、支持药物依从性、自我管理）。主要结果是在基线和 12 个月时采用 TBC 进行 HTN 管理的情况。次要结果包括 BP 控制率和 18 个月时 TBC 和 BP 结果的可持续性。所有集群每 6 个月收集一次 BP 测量的汇总数据，以便每个集群在对照和干预条件下都提供数据点。我们将使用混合方法，还将探索组织和团队层面影响 PF 效果的因素。
本研究将为如何优化独立基层医疗环境中 TBC 的采用和可持续性提供急需的指导，以减少与 BP 控制不佳相关的疾病负担，并深入了解促进如何发挥作用以改善循证干预措施的实施。
ClinicalTrials.gov；NCT05413252。
