A substantial number of cardiovascular deaths can be averted if blood pressure is controlled. Studies show that optimal blood pressure control prevents 19-56% of coronary heart disease events in men, and 31-57% of coronary heart disease events in women. Evidence shows a modest reduction of 5 mmHg in systolic blood pressure can reduce coronary heart disease events by 9.0% and stroke by 14.0%. Factors that are known to modify hypertension include medication adherence, lifestyle modification, and consistent follow-up with medical providers. Team-based care (TBC), an evidence-based approach delivered by health care professionals such as a nurse, dietician, social worker, or community health worker rather than a physician alone, has been shown to improve blood pressure control. TBC approaches to improve blood pressure control studied so far incorporate some support with medication management, lifestyle modification, self-management, care coordination, communication and follow-up services. Team-based care offered by a nurse has been shown to reduce systolic blood pressure by 4-10 mm Hg.

• Local physicians and Advance Practice Registered Nurses
• Jefferson Regional Medical Center

Results show that community TBC program is of value for rural communities and is successful in reducing high blood pressure. Efforts to create community-clinical linkages among participating providers and LHUs, local pharmacies and community care settings have resulted in coordinated patient referrals, and improved medication adherence, lifestyle changes and blood pressure control. Partnerships among participating physicians, and ADH LHU staff have been strengthened to improve the delivery of care. Continuity of care is being ensured through follow-up reminders, regular   counseling and measurement of blood pressures at the LHUs, with feedback loops among the LHU nurse care managers and physicians. These processes reduce the burden of follow-up visits for patients at participating physician offices.

Strategy 1: Expand partnerships to spread and sustain team-based care for hypertension management in Arkansas communities.

Strategy 2: Determine staff, funding, and training needs for increase workload due to community team-based care.

• Cardiovascular disease prevention and control: Team-based care to improve blood pressure control. Developed by The Community Guide in collaboration with the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention. Available at: http://www.thecom­ munityguide.org/cvd/teambasedcare.html
• Proia KK, Thota AB, Njie GJ, Finnie RKC, Hopkins DP, Mukhtar Q et al. Team-Based Care and Improved Blood Pressure Control: A Community Guide Systematic Review. Am J Prev Med. 2014 July; 47(1): 86-99. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4672378/
• Promoting Team-Based Care to Improve High Blood Pressure Control. Centers for Disease Control and Prevention, 2018. Available at: https://www.cdc.gov/dhdsp/pubs/guides/best-practices/team-based-care.htm