Last year I read an NPR story about
management of blood pressure promoted by barbers in the Los Angeles area led by
certified pharmacists of the American Society of Hypertension. In January of
this year, the study was published with the results of the research.
Hypertension
is among the highest in African American males, with death rates being 3x
higher in black males than white males of the same age (Victor et al., 2019).
Barbershops are a known place of comfort and gathering for African American
males, a place where trust and companionship is created. Given the high
instances of hypertension in black males, Dr. Ronald Victor with a grant from
the National Institute of Health trained 52 barbershops from around the city to
take patients blood pressure. An enrolled cohort of 319 black male patrons were
recruited with a systolic blood pressure of >140 mmHG and were assigned to either
the control group, where barbers promoted follow up with primary care providers
and life style changes, or the intervention group, where barbers followed up
with a pharmacist who then prescribed blood pressure medication under collaboration
with the patrons primary care doctor. Results were significant; Over 12 months,
barbers who promoted this implementation saw a sustained reduction in blood
pressure. In the intervention group, the baseline systolic blood pressure was
152.4 mmHG and after 12 months fell to 123.8 mmHG while the control group
baseline was 154.6 mmHG and after 12 months fell to 147.4 mmHG.
Clearly
the intervention group vastly improved, by working in conjunction with the
barber, pharmacist, and primary care doctor. Though there was improvement in
the control group, which is important, it goes to show how holistic care can be
broadened to impact a patient’s healthcare choices.
Given the
success of this research, is it ethical for someone such as a barber, nail
tech, or esthetician to try to impart a health intervention, especially since
places like this are “safe places for talking”? Since the health promotion by these barbers
showed a reduced and sustained blood pressure in the patrons/patients treated,
it has shown that people who we encounter on a daily basis can greatly aid in
our health care decisions, however to what extent is there a line crossed in
such intervention, if any?
What factors must be present for you as a patient to get on
board with their recommendations? Since the National Institute of Health heavily
funded this research, there was much care in choosing the patients who
qualified as well as sufficiently training the barbers and having the patients
cooperate with the study. Do you see any violations in ethical principles and
or what principles did the barbers as well as the pharmacists/primary care
doctors impart on these patrons?
Victor et al., 2019. Sustainability of Blood Pressure Reduction in Black Barbershops. Circulation. 139. 10-19. DOI: 10.1161/CIRCULATIONAHA.118.038165
Alex-
ReplyDeleteThis is a very unique approach to primary care and one that I have personally never even considered. In regards to the ethics presented by this study, I don't necessarily think that it is ethical or safe for people who are non-certified in a healthcare field to give medical advice. It is a tricky line to walk, with potential for mistakes and personal opinions. We have seen the effects of such people in the media and on social platforms like Facebook doling out advice that leads to illness; specifically, the anti-vax community comes to mind here.
On the other hand, I do see a great benefit to utilizing community spaces to improve the health of areas where people may have limited access to health care or where there is some fear/distrust of doctors. I personally believe that community initiatives should always be a first line of action when it comes to primary care issues that affect many people. Education is the best tool health care providers have, and the more ways we can accomplish that goal, the better. In addition, for easily treatable issues this would be a great model to lessen burden on clinics and ERs.
If this were to become a more widespread model, I think a regulatory body would need to be established to standardize how these operations run; as well as, thorough training and monitoring would be required in order to ensure safe practices. This is a very interesting idea and I hope more places do research on this creative solution to see its viability!
There is a program like this in Colorado called the Black Barbershop/Salon Health Outreach by the Colorado Black Health Collaborative (CBHC). It has screen thousands for hypertensions and diabetes. They have operated in 15 barbershops across the Metro Area. I think programs like this are so important because it helps healthcare reach a wider population and serve those who may be underserved in their communities. In regards to the question of whether barbers or technicians should be responsible for the health of their clients, I think they shouldn't be responsible, but could help promote programs like the one in Colorado. To the best of my knowledge, health care providers and volunteers come to the barber shops and evaluate patients there, in a location that is comfortable to the patients. The healthcare providers that operate these programs are well trained and have trained volunteers to accurately measure blood pressure and screen for diabetes. I think models like this truly help reduce the health care disparities that exist in marginalized populations because it reduces the problem of limited access to care, which allows the preventable diseases to be detected earlier before it manifests itself into bigger problems.
ReplyDeleteColorado Black Health Collaborative (CBHC). (n.d.). Retrieved December 7, 2019, from https://coloradoblackhealth.org/