Barber and Pharmacist Coordination to Improve Blood Pressure Management

Hypertension (HTN) is a major risk factor for multiple morbid conditions. During the first grant period, our team successfully conducted a cluster-randomized trial of a community-centered blood pressure (BP) reduction program of 319 non-Hispanic (NH) Black men within 52 Black-owned barbershops in Los Angeles, CA (Los Angeles Barbershop BP Study [LABBPS] R01HL117983). The intervention was highly effective conferring marked reductions in systolic BP of 21.6 mmHg in 6-months that were sustained at 1 year; however, critical data on longer term BP control are needed to justify the costs of scaling this successful intervention. Additionally, while highly effective, the current LABBPS model, which involved in-person visits with clinical pharmacists in barbershops, is not only resource intensive but also has constrained scalability due to the inefficiencies of pharmacist travel to and between shops across wide geographic regions. These limitations have resulted in stunted translation of this evidence-based intervention into clinical practice. In this renewal application, we will leverage the existing, one-of-a-kind LABBPS cohort and barbershop community to address both barriers to widespread adoption by: 1) assessing the long-term impact of the 1-year LABBPS intervention on BP and adverse HTN-related outcomes in the original LABBPS population - and - 2) adapting the intervention in the LABBPS barbershops to be more cost-effective and less resource intensive by transitioning the in- person clinical pharmacist’s HTN management to a telemedicine platform based in the barbershops. In Aims 1 and 2, to assess long-term BP control and outcomes, we will perform in-person follow-up visits with the original LABBPS participants in the barbershops and ascertain/review updated medical records to confirm HTN- related cardiovascular, renal, and mortality outcomes. In Aim 3, to adapt the in-person LABBPS model to a barbershop-rooted, telemedicine HTN management program, we will use rigorous implementation science methods along with input from our established community stakeholder advisory board. The ADAPT-ITT and RE- AIM implementation science frameworks will be used to theater test and assess the feasibility and acceptability of modifying the LABBPS clinical pharmacist’s role from in-person within the barbershops to a telemedicine video platform also located in the barbershops. This adaptation study will be conducted in 10 of the original LABBPS barbershops where 50 new NH Black patrons with HTN will be enrolled. Following implementation, effectiveness of the adapted intervention will be assessed by comparing the achieved reduction in systolic BP at 6 months to that obtained in the original in-person LABBPS intervention. Achievement of these aims will provide critical data needed to support the broader adoption of an evidence-based community-centered HTN control program for NH Black men who are at high risk of HTN-associated morbidity and mortality.