Combining barbers and pharmacists may be a good way of getting to a traditionally hard-to-reach population that is at risk for hypertension.
Black men have the highest rate of deaths related to hypertension of all groups in the United States. They are also less likely to see a doctor or another healthcare provider than black women. Barbershops in the African American community have long been known to serve as social centers for black men. Interactions with pharmacists are also known to help patients lower their blood pressure.
Researchers at Smidt Heart Institute at Cedars-Sinai, Los Angeles, decided to combine both factors in one study. They worked with 52 black-owned barbershops in the Los Angeles and identified more than 300 men with systolic blood pressure over 140 mmHg.
Some of the shops, the control group, were then assigned to give information to those participants about their blood pressure and encourage lifestyle changes and making doctor appointments when they came in for haircuts. The other shops, the intervention group, had the barbers encourage the participants to meet in the shop with two clinical pharmacists who came in regularly to meet with them.
The results were significant. At 6 months, the mean systolic blood pressure fell by 27.0 mmHg in the intervention group who met with pharmacists and by 9.3 mmHg in the control group who just got advice.
Ciantel Adair Blyler, PharmD, CHC, is one of the two clinical pharmacists and a coauthor of the study. She answered some questions from Valerie DeBenedette, managing editor of Drug Topics, about the study by email.
DT: What was the initial reaction of the barbershop customers?
Blyler: Generally, the reception at each barbershop was very warm and welcoming. Initially, I think there was some wariness of dealing with us as healthcare providers. This was to be expected since mistrust of the medical establishment has historical roots in the black community and is often why so few black men seek medical care. However, I would say that this was quickly overcome. I think that when you meet people “where they are” there is a different level of respect and trust that is earned.
Barber endorsement was also essential and cannot be overstated. Their support of the program made our job a much easier one.
DT: What were the interactions with patients like?
Blyler: Patients were seen every two to six weeks for medication adjustments and monitoring. Blood pressure was evaluated at each visit and we were able to check plasma electrolytes (when needed) with an iSTAT point-of-care device. We discussed the importance of lifestyle modifications at the study’s outset, but once participants were on a stable regimen and blood pressure approached the study goal of <130/80 our focus really shifted from medication counseling to lifestyle counseling at most visits (diet, sodium intake, exercise, smoking cessation, etc.).
DT: How did you provide privacy when meeting with participants at the barbershop?
Blyler: Most shops had private break rooms or storage space that we could use to see participants. For those shops without private rooms, we would meet participants just outside the shop or grab a quiet corner in the waiting area.
DT: How was the prescribing handled?
Blyler: We prescribed antihypertensive medications under a collaborative practice agreement with the participant’s primary care providers. Prescriptions were sent to the patient’s pharmacy just as they would be from a doctor’s office. Medications were not provided as part of the study, so they used their insurance to get medications. If they were uninsured we did have a small retail pharmacy that provided the medication at very low cost ($4 to $10 for a month’s supply).