Background Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The purpose of this study was to evaluate the effectiveness of a physician/pharmacist intervention to improve BP control. Methods This was a prospective, cluster-randomized controlled clinical trial with clinics randomized to control (n=3) or intervention (n=3) groups. The study enrolled 402 patients with uncontrolled hypertension (mean age 58.3 years). Clinical pharmacists made drug-therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring. Results Guideline adherence scores increased from 49.4 ± 19.3 at baseline to 53.4 ± 18.1 at 6 months (9% increase) in the control group and from 40.4 ± 22.6 to 62.8 ± 13.5 (57% increase) in the intervention group (p=0.089 adjusted comparison between groups). Mean BP decreased 6.8/4.5 and 20.7/9.7 mm Hg in the control and intervention groups, respectively, (p<0.05 for between-group systolic BP (SBP) comparison). The adjusted difference in SBP was −12.0 (95% CI: −24.0, 0.0) mm Hg, while the difference in diastolic BP (DBP) was −1.8 (CI: −11.9, 8.3). The 24-hour BP levels showed similar effect sizes. BP was controlled in 29.9% of patients in the control group and 63.9% in the intervention group (adjusted odds ratio 3.2; CI: 2.0, 5.1; p<0.001). Conclusions A physician/pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates when compared to a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management.

Background The purpose of this study was to evaluate if a physician/pharmacist collaborative model would be implemented as determined by improved blood pressure (BP) control in primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control could be sustained. Methods and Results Prospective, cluster-randomized trial of 32 primary care offices stratified and randomized to: control, 9-month intervention (brief), 24-month intervention (sustained). We enrolled 625 subjects with uncontrolled hypertension; 54% from racial/ethnic minority groups, and 50% with diabetes or chronic kidney disease (CKD). The primary outcome of BP control at 9 months was 43% in intervention offices (n=401) compared to 34% in the control group (n=224) (adjusted odds ratio [OR] 1.57 [95% CI 0.99–2.50], p = 0.059). The adjusted difference in mean systolic/diastolic BP between the intervention and control groups for all subjects at 9 months was −6.1/−2.9 mm Hg (p =0.002 and p=0.005, respectively), and it was −6.4/−2.9 mm Hg (p=0.009 and p=0.044, respectively) in subjects from racial or ethnic minorities. BP control and mean BP were significantly improved in subjects from racial minorities in intervention offices at 18 and 24 months (p=0.048 to p<0.001) compared to the control group. Conclusions While the results of the primary outcome (BP control) were negative, the key secondary endpoint (mean BP) was significantly improved in the intervention group. Thus, the findings for secondary endpoints suggest that team-based care utilizing clinical pharmacists was implemented in diverse primary care offices and BP was reduced in subjects from racial minority groups. Clinical Trial Registration Information NCT00935077: http://clinicaltrials.gov/ct2/show/NCT00935077

Abstract-Adherence to practice guidelines is frequently used as a measure of quality of care. Numerous studies have evaluated physician adherence to hypertension guidelines by prescription data, physician survey data, or medical record review. However, most have methodological limitations that might underestimate physician adherence. Accurate and meaningful characterization of adherence rests on evaluation of varied components of hypertension care, use of explicit validated performance measures, incorporation of implicit and explicit review, and linkage of process measures to blood pressure outcomes. Key Words: hypertension, detection and control Ⅲ population Ⅲ lifestyle Ⅲ epidemiology P ractice guidelines serve as useful tools for clinical decision making. Guidelines are used to reduce practice variation, guide appropriateness, and measure quality of care. 1,2 Ultimately, the goal of a guideline is to improve patient outcomes through a change to evidence-based physician practices. Unfortunately, substantial gaps have been documented between the development and dissemination of consensus statements and their implementation in practice. In short, clinical practice guidelines do not consistently change physician behavior. [3][4][5][6][7] Although the National Heart, Lung, and Blood Institute (NHLBI) has published 7 guidelines for the treatment of hypertension, 8 -14 control of high blood pressure remains suboptimal. An estimated 40% of the 50 million persons in the United States with hypertension remain untreated, and 66% of hypertensive patients have blood pressure values that are not controlled to the recommended levels. 14,15 Many studies have concluded that physician adherence to hypertension guidelines has been low. 16 -22 It is tempting, therefore, to connect poor blood pressure control to poor adherence to hypertension guidelines.However, valid and meaningful conclusions regarding physician adherence and its link to blood pressure control rest on the completion of 2 tasks. First, physician adherence to hypertension guidelines must be assessed accurately. Second, the relation between physician adherence and blood pressure control must be empirically demonstrated.This article reviews pertinent literature regarding physician adherence to hypertension guidelines and the relation of adherence to blood pressure outcomes. The review focuses on methods that limit evaluation of adherence and concludes with recommendations for strengthening future adherence research. Literature SearchA literature search using MEDLINE from 1966 to 2004 was conducted by combining the terms "guideline adherence" and "hypertension." English articles were screened for inclusion by review of the title and abstract. A copy of all studies that compared prescribing trends or physician practice to guideline recommendations was obtained. Bibliographies of chosen references were reviewed for additional citations. Articles that compared physician practice to recommendations of the Joint National Committee (JNC) on the Detection, Evaluation, and ...

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Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability: lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now trial randomized 625 patients from 32 medical offices in 15 states. Each office had an existing clinical pharmacist on staff. Pharmacists in intervention offices communicated with patients and made recommendations to physicians about changes in therapy. Demographic information, blood pressure, medications and physician visits were recorded. In addition, pharmacists tracked time spent with each patient. Costs were assigned to medications, and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in blood pressure measurements and hypertension-control rates. Thirty-eight percent of patients were black, 14% were Hispanic, and 49% had annual income <$25,000. At 9 months, average systolic blood pressure was 6.1 mm Hg lower (+/− 3.5), diastolic was 2.9 mm Hg lower (+/− 1.9), and the percentage of patients with controlled hypertension was 43% in the intervention group and 34% in the control group. Total costs for the intervention group were $1462.87 (+/− 132.51), and $1259.94 (+/− 183.30) for the control group, a difference of $202.93. The cost to lower blood pressure by 1 mmHg was $33.27 for systolic blood pressure and $69.98 for diastolic blood pressure. The cost to increase the rate of hypertension control by one percentage point in the study population was $22.55. Our results highlight the cost-effectiveness of a clinical pharmacy intervention for hypertension control in primary care settings.