I’m willing to bet that hypertension would be less prevalent and better controlled if blood pressures were as tangible as the hair on a person’s head. This might sound ridiculous, but just think about how much time people devote to their hair – they comb it, wash it, and routinely trim it. Even if this time commitment is at a minimum, personal grooming is a cultural norm which stands to gain positive feedback from others in the community if well maintained.
Unfortunately, a person’s blood pressure lacks this routine visibility, maintenance, and cultural support. As a result, hypertension affects millions of people and, from my experience, some patients struggle to achieve clinician-desired blood pressure goals with recommended lifestyle modifications and optimal medical management. I find that patients cannot immediately appreciate the effects of hypertension quite like they can a bad hair day.
I provide this analogy as a foundation for a recent study published in the New England Journal of Medicine, which has implications for increasing high-value health care in Virginia. In the study, “A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops,” researchers report a significant reduction in systolic blood pressure (SBP) in participants with historically uncontrolled hypertension after receiving health promotion by their barber coupled with promotion of medication management by a pharmacist in the barbershop when compared to a control group which had health promotion by their barber and recommendation of participant follow-up with a physician. The researchers found that those participants that had access to a pharmacist in the barbershop achieved a mean SBP reduction over 25 mm Hg, with the majority obtaining a blood pressure below 130/80 after six months of intervention.1 By fostering discussion about hypertension and by placing an expert in targeted, patient-convenient location but nontraditional clinical location, the researchers were able to construct a culture that empowered participants to make a change and assume ownership of their blood pressure management.
This study validates the need and value of increased clinician involvement in the communities they serve. As agents of change, how can we employ lessons from this research to increase high-value health care for Virginians? Where in your communities could patients benefit from a clinician being in a nontraditional health care setting? How can your healthcare system support community dialogues about chronic health disparities, like hypertension?
I believe physician assistants (PAs) are a solution to efficiently expanding health care services to the diverse communities we serve. As versatile and collaborative members of the healthcare team, PAs can handle growing need for high-value health care in Virginia.
1. Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., Rashid, M., Hsu, B., Foxx-Drew, D. & Moy, N. (2018). A cluster-randomized trial of blood-pressure reduction in black barbershops. New England Journal of Medicine, 378(14), 1291-1301.