Back to Basics in Health Care: Barbershops, High Blood Pressure and Better Outcomes

In the U.S., we spend more money per capita on health care as a percentage of GDP than any other industrialized nation in the world. Yet our clinical outcomes are no better than the average (and worse than many countries that spend far less than we do). Our system is far more complex than others, much more expensive and often difficult to access. Many patients struggle to engage and partner with a health care provider, and the logistics of attending a visit with a physician can be difficult for the working poor, those with families and others with multiple obligations and roles to play in the family. Going to a physician's office to see a provider can involve transportation challenges, time away from work and expensive insurance co-pays (assuming you actually have insurance). In addition, medications can be cost-prohibitive, and treatment regimens can be complicated and difficult to understand. Visits with the doctor can be rushed (as physicians are pushed by administrators to see more people in less time) and leave many patients with more questions than answers. Moreover, after leaving the doctor's office, many of us may be confused, and new questions inevitably pop up as soon as we leave the clinic.

[See: 11 Questions You Should Ask Your Cardiologist During Your First Visit.]

Finding a Better Way

How care is delivered can determine how well patients respond to new treatments. One of the most critical factors in improving outcomes is the engagement between health care provider and patient -- when patients are invested in their own treatment plan for diseases such as diabetes and high blood pressure, they have much better control and fewer long-term complications. At the recent American College of Cardiology Annual Scientific Sessions, one of the most important clinical trials in decades was presented. Interestingly, the trial did not involve a new expensive drug or a new expensive test or surgery. It simply examined how outcomes improved when patients were engaged around a particular chronic disease on their own turf: local barbershops in Los Angeles.

In the study, researchers from Cedars Sinai in Los Angeles found that if they counseled patients and actually had pharmacists bring medicines to men in their local barbershops, they had a much more significant reduction in blood pressure as compared to those who did not receive the same service. For many African-American males, the local barbershop is a place to socialize with friends, discuss the news of the day and share their daily life challenges. The trial, published in the New England Journal of Medicine, involved more than 300 black men who regularly visited local barbershops. These men were either entered into an intensive counseling and treatment program with pharmacists (conducted at the local barbershop) or received lifestyle modification encouragement (like seeing their doctor regularly) by the barbers on duty.

At baseline, all men enrolled in the trial were found to have high blood pressure. After the study was completed, a huge difference in blood pressure reduction was seen between the two groups -- at the conclusion of the trial, 65 percent of the men in the pharmacist-led group met blood pressure guidelines, as compared to only 11 percent in the control group. The significance of this study is compounded by data from the American Heart Association that makes it clear that black males have a disproportionately high risk for high blood pressure-related complications such as heart attack and stroke. We also know that medication compliance in hypertension among black males is much lower as compared to other demographics. Moreover, black males are far too underrepresented in clinical trials in hypertension. By demonstrating the ability to positively impact African-American males with hypertension by using their barbershops as a point of care, providers may need to reevaluate just how care is delivered.

[See: The Best Foods for Lowering Your Blood Pressure.]

Why Is This Trial So Impactful?

Blood pressure is the silent killer. Treatment of blood pressure should be individualized and requires a commitment from both doctor and patient. Our health care system often makes it difficult for patients to bond with their providers. Doctor's offices can be intimidating places, and many Americans don't feel comfortable going to a traditional medical setting. By coming to the men in an environment where they're comfortable -- like a barbershop -- health care providers can make a bigger impact.

In addition, when men are treated in a local environment with their friends, they're more likely to feel a sense of accountability for compliance. Most significantly, however, this trial shows us that we can spend far less money and realize a significant impact when it comes to the treatment of very common diseases like high blood pressure. Doctors and patients must get back to basics when it comes to health care. Making a connection and developing a relationship is vital to success. Rather than expecting patients to come to a health care facility, we must work to provide more convenient touch points -- such as telemedicine, mobile health and .... barbershops.

[See: 10 Ways to Lower Your Risk of Stroke.]

What's Next?

This study should serve as a wake-up call to doctors, patients, politicians and those who determine how health care is delivered in the United States. We must focus more on the patient -- taking medicine where he or she is -- and we should not always force patients to come to big health care systems. Patients must be allowed to receive care on their own turf.

We must make sure that physicians are encouraged to reach out to patients and are not confined to a clinic or hospital. It is vital that we spend the time to better understand our patients and why they feel more comfortable in certain settings. One size does not fit all; cultural differences, socio-economic status and personal beliefs can have a great impact on who benefits from treatment in a particular environment and by a particular provider.

Most importantly, this study proves that it does not take expensive tests, expensive medicines or therapies to make an enormous impact. It's time to step back and put patients first, and if that means going to a barbershop to deliver care, then that's what we must do.