Kevin R. Campbell, MD, FACC
We spend more money per capita in the United States on Healthcare as a percentage of GDP (Gross Domestic Product) than any other industrialized nation in the world. Yet our clinical outcomes are no better than the average (and worse than many countries that spend far less than we do). Our system is far more complex than others, much more expensive and often difficult to access. Many patients struggle to engage and partner with a healthcare provider and the logistics of attending a visit with a physician can be difficult for the working poor, those with families and others with multiple obligations and roles to play in the family.
This past week at the American College of Cardiology Annual Scientific Sessions, one of the most important clinical trials in decades was presented. The trial did not involve a new expensive drug or a new expensive test or surgery. It simply examined how outcomes improved when patients were engaged around a particular chronic disease on their own turf.
In the study, researchers from Cedars Sinai in Los Angeles found that if they counseled patients and actually had pharmacists take medicines to black males in their local barbershops, that they had a much more significant reduction in blood pressure as compared to those who did not receive the same service. Published in the New England Journal of Medicine, the trial involved over 300 African American patients who were entered into one of two study groups–either an intensive counseling and treatment program with pharmacists (conducted at the local barbershop) or a second group that received lifestyle modification encouragement (such as seeing their doctor regularly) by the barbers on duty. Upon completion of the study, a huge difference in blood pressure reduction was seen between the groups with 65% of the men in the pharmacist led group meeting blood pressure guidelines as compared to only 11% in the control group. The significance of this study is compounded by data from the American Heart Association that makes it clear that black males have a disproportionately high risk for high blood pressure related complications such as heart attack and stroke. We also know that medication compliance in hypertension among black males is much lower as compared to other demographics. Moreover, black males are far too underrepresented in clinical trials in hypertension.
Why Is This Trial So Impactful?
Blood pressure is the silent killer. Treatment of blood pressure should be individualized and requires a commitment from both doctor and patient. Our healthcare system often makes it difficult for patients to bond with their providers. Doctor’s offices can be intimidating places and many Americans do not feel comfortable going to a traditional medical setting. By coming to the men in an environment where they are comfortable—such as a barbershop—healthcare providers can make a bigger impact. In addition, when men are treated in a local environment with their friends, they are more likely to feel a sense of accountability for compliance. Most significantly, however, this trial shows us that we can spend far less money and realize a significant impact when it comes to the treatment of very common diseases such as high blood pressure. Doctors and patients MUST get back to basics when it comes to healthcare. Making a connection and developing a relationship is vital to success. Rather than expecting patients to come to a healthcare facility, we must work to provide more convenient touch points—such as telemedicine, mobile health and….barbershops.
What is Next?
This study should serve as a wake-up call to doctors, patients, politicians and those that determine how healthcare is delivered in the United States. We must focus more on the patient—take medicine where they are—we should NOT always force patients to come to big healthcare systems. WE must make sure that physicians are encouraged to reach out to patients and not confined to a clinic or hospital. It is vital that we spend the time to better understand our patients–why they feel more comfortable in certain settings. One size does not fit all–cultural differences, socio-economic status, and personal beliefs can have a great impact on who benefits to treatment in a particular environment and by a particular provider. Most importantly, this study proves that it does not take expensive tests, expensive medicines or therapies to make an enormous IMPACT. It is time to step back and put patients first—if that means going to a Barbershop to deliver care—then that is what we MUST do.