Jewish link Mexico and Israel – A new analysis of a landmark Cedars-Sinai study and new research on telemedicine show how pharmacists and hairdressers can be cost-effective in controlling blood pressure in black men.
A new review of data from a landmark Cedars-Sinai study on health interventions in black hair salons, and a new study examining virtual visits from salon owners to pharmacists, have added to the evidence that community health programs can be used in convenient locations become cost effective in controlling high blood pressure and preventing heart attacks and strokes.
Black men are more likely than white men to have hypertension or uncontrolled high blood pressure which can damage the heart, brain and kidneys. They will also be less likely to see their doctors for preventative care.
In 2015, Cedars-Sinai began collaborating with hairdressers to try to reach these men on familiar ground.
Marcus Byrd believes in this kind of reach. “I go to the salon faithfully every week,” said the 54-year-old research participant, whose blood pressure is at a healthy level for the first time in 20 years. “As black men we do not want to go to the doctor because we want to stay manly, we want to stay healthy in the eyes of the people. But we do go to the hairdresser, because we want to look good ”.
A historical study
The first expert to undergo scientific health interventions in hairdressing was the late Ronald G. Victor, MD, then associate director at the Smidt Heart Institute. For his study of the barber shop in Los Angeles, Victor recruited 319 black men with high blood pressure from 52 barber shops in Los Angeles.
The hairdressers encourage the participants to follow up with visiting pharmacists, who every two to four weeks measure the blood pressure of customers in hairdressing salons and prescribe medicines in collaboration with doctors for primary care.
“Ron Victor was a visionary,” said Dr. Eduardo Marbán, MD, PhD, director of the Smidt Heart Institute and the Distinguished Professor Mark S. Siegel Family Foundation.
“His paradigm was pioneering work in bringing medical care to the patient, instead of the patient to medical care, not only saving lives but also saving money,” he added.
Results after six and 12 months, published in 2018 in The New England Journal of Medicine and in Circulation, found that 64% of participants were able to lower their blood pressure to healthy levels and keep it under control for a year.
As part of a research analysis, researchers from Columbia University and the University of California, San Francisco recently reviewed the data and found that hair salon programs could prevent nearly 40% of heart attacks and strokes among Black men. Participants as it were expanded to the national level.
Researchers measure the cost-effectiveness of medical interventions by comparing their costs against the quality and quantity of life spent for the patient, the dollar amount per quality-adjusted life year QALY. Programs that cost less than $ 50,000 per QALY are considered cost-effective, and Columbia researchers found that the original salon program cost $ 43,000.
The results, published June 14 in Circulation, also suggested that costs could be reduced to $ 17,000 per QALY by using generic drugs alone, and even lower as pharmacists travel time to and from hairdressing salons.
“During the original study, I traveled from Cedars-Sinai to hair salons to Bellflower,” said C. Adair Blyler, PharmD, one of two clinical pharmacists at the Smidt Heart Institute who worked on the study.
“It’s every 45 minutes to an hour’s drive, which means I did not provide patient care for up to a quarter of my day, an inefficiency that contributed to the cost of the intervention,” he added.
To see if telemedicine could reduce travel time with the same benefits for patients, Blyler recruited 10 salon owners for a proof-of-concept study.
From December 2018 to March 2020, he worked personally with clients and then moved them to virtual visits once when their blood pressure was at a healthy level, normally three to six months.
The results of that study, published June 22 in the Journal of the American Heart Association, showed that virtual visits were just as effective.
“In this new version of the model, the barber can set up the blood pressure cuff and we can do these visits remotely there directly from the barber shop without me having to travel,” Blyler said.
Byrd saw information about the study published in Hair Masters in Gardena and decided to enroll in hopes of controlling the “roller coaster” of his blood pressure.
Since 2000, his primary care physician had prescribed various medications, but when they did not seem to help, Byrd became frustrated and did not take them regularly.
Blyler taught Byrd on the basis of blood pressure, how medications may work differently in different people, and about the need to take their medications as indicated.
“She caught my eye,” Byrd said. “I took the medicine and came out super excited.”
Over the next few months, Hairstylist Byrd checked her blood pressure at each visit, and Blyler gradually adjusted her medication.
“The blood pressure went down, the blood pressure went down, the blood pressure went down,” Byrd said. “And once I ran in and I had a target blood pressure, and I was upset. That was the first time in years that my blood pressure was under control.”
Because Blyler had won the trust of Byrd, he said that virtual tours were only as good as interaction in person.
“I don’t care if we talk with a look and a rope,” he said. “I will listen to it. I will follow your advice.”
Hair stylist Devon Hamilton, owner of Soulful Shears in Palos Verdes, was recruited for the study by a fellow hairdresser and began checking the blood pressure of several of his clients, with similar results.
“I felt it was a good idea,” Hamilton said. ‘There are guys at the salon who are against checks and they don’t really check their health. One of my good friends found out that he had high blood pressure and he actually started exercising and losing a few pounds, and he is doing really well now. It changed his whole lifestyle. “
Blyler is hopeful that haircut programs can be scaled nationally. A study conducted in Nashville, Tennessee, which has a larger black population than Los Angeles, Blyler and his colleagues are working on a five-year follow-up with the original study participants.
At the same time, he said, hearing studies also demonstrate how pharmacists can help underserved patients.
“Pharmacists are essential and highly accessible members of the healthcare team and can help manage chronic conditions such as hypertension in any institution,” Blyler said.
“Now we are looking for programs to reach black women and the Latino community, where there is also a high prevalence of uncontrolled hypertension, through beauty salons or churches,” he added.
For men like Byrd, who is married to a 24-year-old daughter and a 27-year-old son, a hearing intervention made the difference. He even applied what he learned from Blyler to control his diabetes.
“A lot of people my age can’t survive due to diabetes,” he said. “They can not do it because of high blood pressure. And those two factors are the number one killer in my culture, because we just do not go to the doctor. “
In a recent email, Byrd’s doctor told him that his blood sugar was now under control and asked what he had done.
“I’m following the instructions,” Byrd replied.
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