Men who get their blood pressure checked at the barbershop
The Public Health Agency of Canada says more than one in five Canadians has high blood pressure. And many of them don't know it. A study published Monday shows an unusual way to put patients in the loop: get your blood pressure checked by your barber or hair stylist.
Fifty-two barbershops in Los Angeles Country were recruited to be part of the study. The barbers were trained to measure blood pressures with an automated blood pressure machine. They used a specific protocol in which they took five readings in a row. The first two readings were discarded to reduce the impact of anxiety or apprehension artificially raising the pressure; the final three readings were averaged to obtain the customer's blood pressure.
The barbers were also trained to make sure the customer had been sitting for five minutes before the first blood pressure reading. They took measurements with the arm at the level of the heart with feet flat and back supported. They were also instructed to make sure customers went to the bathroom before taking the first reading if they had an urge to pee. The blood pressure readings were uploaded automatically to a secure web site.
There were two study groups. In the intervention group, barbers measured blood pressure and suggested that the customer follow up with a pharmacist who prescribed blood pressure medication in collaboration with the customer's family doctor. In the control group, barbers also measured the customer's blood pressure and sent the patient to their family doctor. The barbers in the control group also had a prepared script in which they suggested that the customer do things like losing weight and getting more exercise.
Don't discount barbershop factor
The results were impressive. The average systolic or top number blood pressure reading at the beginning of the study was just over 152 mm Hg. Six months in, the customers sent to their family doctors saw their blood pressure drop to 147, a tiny improvement. Those sent to the pharmacist saw their blood pressure fall to 123.8 mm Hg, an improvement of 28.6 mm Hg. Those results were reported previously in the New England Journal of Medicine.
The current study, which followed customers for a full year, showed the same benefits even though they had fewer follow-up visits to the pharmacist.
Chalk up part of the program's success to the fact that that the pharmacists were more aggressive in prescribing blood pressure pills than doctor guidelines recommend routinely.
But you can't discount the barbershop factor.
This was an intervention tailor-made for men. Many studies have shown that men don't visit their doctors. Some are afraid of physicians and others don't trust their advice. The idea is to bypass the doctor and check blood pressure wherever men tend to go. By that logic, a hardware store or even a sports bar could be far better options than the clinic.
And it's not the only setting where the social approach has worked. Last year, White Coat, Black Art did a show about seniors who call 9-1-1 because they have no one to take them to the doctor and because they're too ill to travel long distances by public transit. Enter community paramedics who are specially trained to do primary care instead of responding to emergencies.
A pilot program saw community paramedics do blood pressure checks at clinics located right inside the subsidized apartment buildings where the people (who call 9-1-1 frequently) live. Researchers found that seniors came to the clinics to get their blood pressure and blood sugar checked and then stayed for the remainder of the day to socialize with fellow residents. The program saw a significant reduction in blood pressure readings and in 9-1-1 calls.
The authors of the study say an initial pilot program is underway in several cities to see if the results can be replicated elsewhere. Programs like the one in Los Angeles often have trouble being scaled up to serve the entire population. The researchers say that the pharmacists involved in the study spent a lot of time travelling to and from barbershops to train barbers and to establish trust. It's unlikely that sort of hand holding will be replicated in future studies. They suggested that telemonitoring in which the pharmacist and barber talk to one another by secure video might be an effective substitute.
That this model worked in the U.S., where pharmacists have had trouble getting prescribing privileges, is a good sign. That means it's likely to work in Canada, where pharmacist prescribing is becoming well established.
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