Can Barbers Cut BP Too? The BARBER-1 Trial (Text Version)

On September 20, 2011, Ronald Victor made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (3 MB). Plugin Software Help.

Slide 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

Slide 2

Our Innovators' Story...

1. Community needs assessment.
2. Intervention development & feasibility studies.
3. BARBER-1: 1st RCT (Dallas).
4. BARBER-2: Coming to LA...

Image of a barber with the words below: "Can barbers cut BP too?"

Image of the symbol of the Texas Association of Tonsorial Agents with the words below: "Mr. James Smith, President"

Slide 3

Community-Level Needs Assessment
The Dallas Heart Study

Dallas

Population Sample (adults < 65Y, 50% Blacks)

Barber-Based Intervention

UT Southwestern

BP less controlled in black men than women.

More black men had a barber than a doctor.

RG Victor et al., Arm J Cardiol 2004; Arch Intern Med 2008

Slide 4

Feasibility Studies:

Study 1–Medical students and staff
Study 2–Barbers as BP "specialists"

Source: Hess PL, Reingold JS, Jones J, Fellman MA, et al. Barbershops as hypertension detection, referral, and follow-up centers for black men. Hypertension. 2007;49:1040-1046.

Slide 5

BARBER-1
Barber-Assisted Reduction of Blood Pressure in Ethnic Residents

Source: Victor RG, Ravenell JE, Freeman A, Leonard D, et al. Effectiveness of a barber-based intervention for improving hypertension control in black men. The BARBER-1 Study: a cluster randomized trial. Archives of Internal Medicine.

On-Line: Oct 25, 2010
Print: Feb 28, 2011

Slide 6

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.

Slide 7

Comparison Group (9 shops, 695 patrons with HTN)

• AHA pamphlets (HTN in Blacks).

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).

Slide 8

Baseline Characteristics— of Male Patrons with HTN

Slide 9

Barbers as Healthcare Partners

Images of an AA-owned barbershop is shown.

Slide 10

Role Model Poster

Image of a poster titled "Health...It's A Family Affair" is shown.

Slide 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).

Slide 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+).

Slide 13

Cost-Benefit

3 mmHg greater fall in systolic BP if applied to the 50% of AA men with HTN in 18,000 barbershops

Cost

• Barber incentives.
• Patron incentives.
• Rx costs.
• $ 200 M in Year 1.

Benefit

• 800 fewer heart attacks.
• 500 fewer strokes.
• 900 fewer deaths.
• $ 110 M in Year 1.

Slide 14

BARBER-2 Trial (in Los Angeles): How to Ehance Intervention Potency?

Flowchart showing:  Barber fidelity and Patron acceptance leads to Pharmacists leads to No more physician inertia leads to Better medical treatment.

Slide 15

Team Science!

Cedars-Sinai

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, Deepa Bhat, 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

Slide 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?