Description of pharmacist interventions during physician–pharmacist co-management of hypertension
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Objective The aim of this study is to describe recommendations made by clinical pharmacists when co-managing hypertension with physicians. Setting Two family medicine clinics at a major teaching hospital in the mid-western United States. Method This report details the specific recommendations made by pharmacists during a prospective randomized controlled clinical trial. Patients with uncontrolled hypertension were enrolled in a 9-month intensive pharmacist–physician co-management study. Clinical pharmacists saw patients at baseline, 2, 4, 6, and 8 month visits. Optional visits were allowed between required visits. Main outcome measure For this analysis, pharmacist recommendations were grouped. Physician acceptance of the pharmacists’ recommendations was also evaluated. Results Data from 101 patients were included and analyzed in this study. Changes in drug therapy were recommended 267 times for these 101 patients. Most recommendations for a change in treatment involved adding a new antihypertensive medication (46.4%) or increasing a dose (33.3%). The majority of pharmacist recommendations to modify drug therapy were made at the baseline visit (41.6%), with 76.8% of recommendations made by the 2 month visit. Physicians accepted and implemented 95.9% of the 267 pharmacist recommendations to modify drug therapy. Pharmacists recommended no change in the treatment plan 361 times, most often because the patient’s blood pressure (BP) had achieved the goal. Average BP decreased from 153.1 ± 10.0/84.9 ± 12.0 mmHg (average ± SD) at baseline to 124.2 ± 9.7/74.7 ± 9.6 mmHg (P < 0.001) at the end of 9 months, with 89.1% (P < 0.001) of patients reaching their BP goal. Conclusion Pharmacist recommendations for alterations in drug therapy generally occurred early in the course of the study and were largely to intensify therapy through higher dosages or additional medications. Pharmacist–physician co-management of BP is effective at reducing BP and improving BP control rates.
KeywordsAmbulatory care facilities Cardiovascular outcomes Clinical pharmacy Hypertension Interventions Pharmacist USA
The authors would like to acknowledge the assistance of Janyce Stewart, RN and Gail Ardery, PhD (project managers); George Bergus, MD, Jeffrey Dawson, ScD, Karen Farris, PhD, William Doucette, PhD, Elizabeth Chrischilles, PhD, and Arthur Hartz, MD, PhD, (study steering committee); Karen Kluesner, RN and Sheryl Eastin, RN (research nurses); Paul James, MD, Christopher Goerdt, MD, and David Katz, MD (data and safety monitoring board).
This project was supported by the National Heart, Lung, and Blood Institute, 1 R01 HL069801-01A1. Dr. Carter is also supported by the CRIISP Center, Iowa City Department of Veterans Affairs.
Conflicts of Interest
Dr. Carter is also supported by the Center for Research in Implementation in Innovative Strategies in Practice (CRIISP), Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HFP 04-149). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Dr. Carter receives funding from NHLBI for another study and he is a paid investigator/educator for the dissemination program: “A Joint Project of the National High Blood Pressure Education Program and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group.” The other authors have no conflicts of interest.
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