Can Barbers Cut BP Too? The BARBER-1 Trial (Text Version)
Slide Presentation from the AHRQ 2011 Annual Conference
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
Our Innovators' Story...
- Community needs assessment.
- Intervention development & feasibility studies.
- BARBER-1: 1st RCT (Dallas).
- 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"
Community-Level Needs Assessment
The Dallas Heart Study
Population Sample (adults < 65Y, 50% Blacks)
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
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.
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
African American-owned Barbershops in Dallas County, TX: 2006-2008
17 study sites.
- 10+ years in business.
- 4 barbers / shop.
- 75 men with HTN / shop.
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).
Baseline Characteristics— of Male Patrons with HTN
(695 men w. HTN)
|Comparison (606 men w. HTN)|
|% w. Income >3X poverty level||54||62|
Barbers as Healthcare Partners
Images of an AA-owned barbershop is shown.
Role Model Poster
Image of a poster titled "Health...It's A Family Affair" is shown.
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).
Paid for Performance...
- Free haircuts ($12 ea.).
- $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+).
3 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.
- 800 fewer heart attacks.
- 500 fewer strokes.
- 900 fewer deaths.
- $ 110 M in Year 1.
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.
Premere Knowles, Anne Feng, Julie Groth, Andre Rogatko, et al.
Rita Shane, Steven Chen, Alison Reta, Sara Niknezhad.
Robert Haley, Anne Freeman, David Leonard, Paul Hess, Deepa Bhat, Patricia Knowles, and many more...
Xavier Univ. & ABC
Univ. of Minnesota
Mark Pletcher , Kirsten Bibbins-Domingo, Pam Coxson.
Martin Shapiro, Suzanne Shu, Robert Elashoff, Kate Crespi.
Charles Drew Univ.
Healthy AA Families
Texas Education Board, AHA
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?