Addressing Racial Disparity Head-On

Volume 4, Issue 3

Unfortunately, the field of medicine is littered with examples of systemic racism and maleficence towards persons of color but a concerted effort is underway in the medical community to address health care disparities and expunge erroneous race-based medical practices. However, because unique physiological and cultural differences still exist, there are situations where race-based medicine could be beneficial, provided the motivation is rooted in sound science. This week’s issue of Talking Therapeutics will discuss a pharmacist-driven intervention found to be effective in improving the health of Black men.

Point 1: Improving Blood Pressure Control in Black Barbershops

Hypertension prevalence remains higher among non-Hispanic Black men than in any other racial or ethnic group in the United States. Furthermore, Black men continue to have worse blood pressure control and higher hypertension-related cardiovascular disease mortality rates—hence, why improving hypertension control among Black men is a national priority. Overcoming mistrust attributable to racism in the health care system and improving health outcomes for Black men is not an easy, one-off task, which is why interventions in community settings outside the traditional medical clinic are needed.

The Los Angeles Barbershop Blood Pressure Study (LABBPS) was built on barber-patron relationships and teamwork between barbers and clinical pharmacists to deliver hypertension care in Los Angeles County Black barbershops. The LABBPS randomly assigned barbershops and their Black patrons with uncontrolled hypertension to either clinical pharmacist blood pressure management in the barbershop (intervention) or barber-delivered education alone (control). After 1 year, the intervention reduced mean systolic blood pressure by 20.8 mm Hg (95% CI, 13.9 to 27.7 mm Hg) relative to the control arm. Blood pressure control <130/80 mm Hg was attained by 68% of participants in the intervention arm and 11% of participants in the control arm.

Point 2: The LABBPS Is Cost-effective and Scalable

A study published just this week in Circulation found that at 10 years, the intervention mentioned above was projected to cost an average of $2356 (95% uncertainty interval, –$264 to $4611) more per participant than the control arm and gain 0.06 (95% uncertainty interval, 0.01–0.10) QALYs. The LABBPS intervention was highly cost-effective, with a mean cost of $42,717 per QALY gained (58% probability of being highly and 96% of being at least intermediately cost-effective). Exclusive use of generic drugs improved the cost-effectiveness to $17,162 per QALY gained.

Closing Remarks

The examples of mistreatment of minority populations are scarred across the annals of medicine. It is therefore incumbent on all of us in health care to proactively seek out and eliminate practices that result in persons of color receiving substandard care

Hopefully today’s column serves as a reminder that while we must continue to address and expunge practices that cause health disparities, race-based medical practices can benefit patients when the science is sound.

Dr Jennings is currently an Associate Professor of Pharmacy at Long Island University and the clinical pharmacist for the Heart Transplant and LVAD teams at New York- Presbyterian Hospital Columbia University Irving Medical Center.  He is an active researcher in his field, and he has published over 120 peer-reviewed abstracts and manuscripts, primarily focusing on the pharmacotherapy of patients under mechanical circulatory support. As a recognized expert in this area, he has been invited to speak at numerous national and international venues, including meetings in France, Saudia Arabia, and India. Finally, Dr Jennings has been active in professional organizations throughout his career. He is a fellow of the American College of Clinical Pharmacy, the American College of Cardiology, the Heart Failure Society of America, and the American Heart Association.  

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