Team-Based Hypertension Management in Primary Care: A Synthesis of Systematic Reviews

BACKGROUND: People with hypertension often require personalised education and support from health professionals to optimise outcomes. Multidisciplinary team-based care in primary care has been proposed as a strategy to empower patients to manage their blood pressure. Although substantial literature reports team-based interventions for hypertension management in primary care, the optimal models and their components remain unclear. AIM: This scoping review critically synthesised existing systematic reviews that have explored elements of team-based care and collaboration among primary care clinicians for hypertension management, and identified knowledge gaps and areas for future investigation. METHOD: Following PRISMA-ScR guidelines, CINAHL and MEDLINE were searched for relevant systematic reviews published in English since 2015 that reported trials of team-based primary care in which blood pressure was an outcome or evaluated interventions for hypertension delivered by a team. RESULTS: Of the 12 reviews that met the inclusion criteria, four (33.3%) included multidisciplinary teams, three (25.0%) included nurse-led teams, and two (16.7%) included pharmacist-led teams. The remaining three (25.0%) reviews evaluated which components of teamwork optimised hypertension management. Regardless of the team composition, most, but not all, reviews demonstrated improvements in blood pressure and other outcomes. Most teamwork components improved outcomes; however, a greater number of team components was associated with better outcomes. CONCLUSIONS: Although the included reviews confirmed the value of team-based care, the specific intervention components that contribute to successful outcomes, the dose of teamwork required, the nature of task-sharing and the cost-effectiveness of team-based models require further investigation. Additionally, clearer reporting of the nature of teamwork, task-sharing and intervention delivery would facilitate comparisons between studies.