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Can barbers cut BP too? the BARBER-1 trial…

Can barbers cut BP too? the BARBER-1 trial…. Ron Victor, M.D. Burns & Allen Chair in Cardiology Research Professor of Medicine, UCLA Director , Hypertension Center Associate Director , Cedars-Sinai Heart Institute. Our innovators’ story…. Community needs assessment

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Can barbers cut BP too? the BARBER-1 trial…

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  1. Can barbers cut BP too? the BARBER-1 trial… Ron Victor, M.D. Burns & Allen Chair in Cardiology Research Professor of Medicine, UCLA Director, Hypertension Center Associate Director, Cedars-Sinai Heart Institute

  2. Our innovators’ story… • Community needs assessment • Intervention development & feasibility studies • BARBER-1: 1st RCT (Dallas) • BARBER-2: Coming to LA… Can barbers cut BP too? Mr. James Smith, President

  3. Community-Level Needs Assessment The Dallas Heart Study Population Sample (adults < 65Y, 50% Blacks) BP less controlled in black men than women Dallas SOUTHWESTERN More black men had a barber than a doctor Barber-Based Intervention RG Victor et al., Arm J Cardiol. 2004; Arch Intern Med. 2008

  4. Feasibility studies: Study 1–Medical students and staff Study 2–Barbers as BP “specialists”

  5. On-Line: Oct 25, 2010 Print: Feb 28, 2011 BARBER-1 Barber-Assisted Reduction of Blood Pressure in Ethnic Residents

  6. Study Shops Other Shops African American-owned barbershops in Dallas County, TX: 2006-2008 225 barbershops • 17 study sites • 10+ years in business • 4 barbers / shop • 75 men with HTN / shop

  7. Comparison Group (9 shops, 695 patrons with HTN) Intervention Group (8 shops, 606 patrons with HTN) No pamphlets Barbers monitored BP and promoted MD follow-up X 10 months Barbers discussed role model posters (personalized peer health messaging) • AHA pamphlet (HTN in Blacks)

  8. Baseline Characteristics— of male patrons with HTN

  9. Barbers as healthcare partners

  10. Role Model Poster

  11. Intervention Fidelity 539 patrons with HTN completed the exit survey in the intervention barbershops: • 410 patrons (76%) reported that their barber discussed model stories. • Barbers recorded 3375 sets of BPs (6 sets/patron=~60% of haircuts). • Barbers gave high BP referral cards to 288 patrons and 176 (66%) returned a signed card (MD-patient interaction).

  12. Paid for performance… Patrons • free haircuts ($12 ea.) Barbers • $3 per valid BP check • $10 per phone call to study staff • $ 50 per referral card signed by MD Research staff & contracts • Scientific evaluation • $ 5+ million in research grants (NIH+)

  13. Cost-Benefit3 mmHg greater fall in systolic BP if applied to the 50% of AA men with HTN in 18,000 barbershops Cost Benefit 800 fewer heart attacks 500 fewer strokes 900 fewer deaths $110 M in Year 1 • Barber incentives • Patron incentives • Rx costs $200 M in Year 1

  14. BARBER-2 Trial (in Los Angeles): How to ehance intervention potency? Barber fidelity Patron acceptance Pharmacists? Non- Adherence Physician inertia Under-treatment of HTN Better medical treatment

  15. Team Science! Premere Knowles, Anne Feng, Julie Groth, Andre Rogatko, et al. Cedars-USC Pharmacy Rita Shane, Steven Chen, Alison Reta, Sara Niknezhad UT Southwestern Robert Haley, Anne Freeman, David Leonard, Paul Hess, DeepaBhat, Patricia Knowles, and many more… Xavier Univ. & ABC Keith Ferdinand Univ. of Minnesota Peter Hannan UCSF Mark Pletcher, Kirsten Bibbins-Domingo, Pam Coxson UCLA CTSI Martin Shapiro, Suzanne Shu, Robert Elashoff, Kate Crespi Charles Drew Univ. Keith Norris Healthy AA Families Loretta Jones PAST FUNDING Reynolds Foundation Texas Education Board, AHA CURRENT FUNDING NHLBI (RO-1 HL080582) Lincy Foundation, UCLA-CTSI

  16. Questions (Barber Intervention) Reach Issue: • How to reach the patrons’ physicians in our fragmented healthcare system? Policy Issue: • How to make barbers’ blood pressure monitoring/referral reimbursable care? Disparity Issues: • How to scale up the barber-based program? • How to benefit more low-income men?

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