Building and testing a team‐based care model in primary care: The heart‐2‐heart blood pressure control partners study

Introduction New models of team‐based care for the chronic management of diverse patients with uncontrolled hypertension in primary care practices remain a compelling need. Objectives This report details the steps that were required to build and test a new team‐based care model for use in a large randomized controlled trial (RCT) that follows Interprofessional Education Collaborative (IPEC) principles. Methods The “Heart‐2‐Heart” study, a two‐arm RCT, was designed to evaluate the effectiveness of a pharmacist‐led team‐based home blood pressure management program versus enhanced usual care in 20 primary care practices across North Carolina. Clinical Pharmacist Practitioners (CPP) are embedded in practices and work with physicians under a collaborative practice agreement (CPA) to deliver comprehensive medication management and nutritionist‐designed lifestyle counseling to patients with a history of uncontrolled hypertension. Interprofessional communication design and CPP roles and responsibilities were informed by IPEC Core Competencies. Remote cellular‐enabled blood pressure (BP) monitors were tested in different rural environments, and study instruments and data collection procedures were evaluated in five patients to optimize the implementation of the parent study. Semi‐structured interviews were held with a Stakeholder Advisory Committee (SAC) and primary care physician (PCP) stakeholders. Results During team development, several workflows and communication issues were identified that warranted modification, and the SAC and PCP stakeholders helped to further shape the study protocol and implementation. The current team‐based care model is now being fully implemented in a RCT that pays attention to the fidelity of the team‐based care delivery model. Conclusion Building a team‐based care delivery model requires careful planning and attention to interprofessional roles and responsibilities and communication strategies. Pharmacist‐led team‐based care models for chronic diseases such as hypertension are feasible and can be structured for optimal evaluation in randomized care delivery models.