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

Can barbers cut BP too?

Mr. James Smith, President

Our innovators’ story…

Community needs assessment

Intervention development &

feasibility studies

BARBER-1: 1st RCT (Dallas)

BARBER-2: Coming to LA…

Dallas

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

Barber-BasedIntervention

SOUTHWESTERN

BP less controlled inblack men than women

More black men had a barber than a doctor

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

Community-Level Needs AssessmentThe Dallas Heart Study

Feasibility studies: Study 1–Medical students and staff

Study 2–Barbers as BP “specialists”

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

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

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

Comparison Group (9 shops, 695 patrons with HTN)

AHA pamphlet (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)

Baseline Characteristics — of male patrons with HTN

Intervention (695 men w. HTN)

Comparison (606 men w. HTN)

Age (y) 49 51Patronage (y) 7 10% w. Income

>3X poverty level

54 62

% Insured 85 85% Married 57 67

Barbers as healthcare partners

Role Model Poster

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).

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+)

Paid for performance…

Cost-Benefit3 mmHg greater fall in systolic BP if applied to the 50% of AA men with HTN in 18,000 barbershops

· 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

Cost

Pharmacists?

Under-treatment of HTN

Physicianinertia

Barber fidelity Patron acceptance

Non-Adherence

Better medical treatment

BARBER-2 Trial (in Los Angeles): How to ehance

intervention potency?

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, 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

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?