Objective To assess the effectiveness and sustainability of a 6-month Team Education and Adherence Monitoring (TEAM) intervention for black patients with hypertension in community chain pharmacies. Design Cluster randomized trial. Setting 28 chain pharmacies (14 TEAM and 14 control) in five Wisconsin cities from December 2006 to February 2009. Participants 576 black patients with hypertension. Intervention Trained pharmacist–technician teams implemented a 6-month intervention using scheduled visits, Brief Medication Questionnaires (BMQs), and novel toolkits for facilitating medication adherence and pharmacist feedback to patients and physicians. Control participants received patient information only. Main outcome measures Refill adherence (≥80% days covered) and changes in systolic blood pressure (SBP), diastolic blood pressure, and blood pressure control using blinded assessments at 6 and 12 months. Results At baseline, all patients had blood pressure of 140/90 mm Hg or more. Of those eligible, 79% activated the intervention (mean 4.25 visits). Compared with control participants at 6 months, TEAM participants achieved greater improvements in refill adherence (60% vs. 34%, P < 0.001), SBP (−12.62 vs. −5.31 mm Hg, P < 0.001), and blood pressure control (50% vs. 36%, P = 0.01). Six months after intervention discontinuation, TEAM participants showed sustained improvements in refill adherence (P < 0.001) and SBP (P = 0.004), though the difference in blood pressure control was not significant (P < 0.05) compared with control participants. Analysis of intervention fidelity showed that patients who received the full intervention during months 1 through 6 achieved significantly greater 6- and 12-month improvements in refill adherence and blood pressure control compared with control participants. Conclusion A team-based intervention involving community chain pharmacists, pharmacy technicians, and novel toolkits led to significant and sustained improvements in refill adherence and SBP in black patients with hypertension.

Abstract-Recent studies suggest that involving pharmacists is an effective strategy for improving patient adherence and blood pressure (BP) control. To date, few controlled studies have tested the cost-effectiveness of specific models for improving patient adherence and BP control in community pharmacies, where most Americans obtain prescriptions. We hypothesized that a team model of adherence monitoring and intervention in corporately owned community pharmacies can improve patient adherence, prescribing, and BP control among hypertensive black patients. The Team Education and Adherence Monitoring (TEAM) Trial is a randomized controlled trial testing a multistep intervention for improving adherence monitoring and intervention in 28 corporately owned community pharmacies. Patients in the 14 control pharmacies received "usual care," and patients in the 14 intervention pharmacies received TEAM Care by trained pharmacists and pharmacy technicians working with patients and physicians. Data collectors screened 1250 patients and enrolled 597 hypertensive black patients. The primary end points were the proportion of patients achieving BP control and reductions in systolic and diastolic BP measured after 6 and 12 months. Secondary end points were changes in adherence monitoring and intervention, patient adherence and barriers to adherence, prescribing, and cost-effectiveness. Researchers also will examine potential covariates and barriers to change. Involving pharmacists is a potentially powerful means of improving BP control in blacks. Pharmacists are in an excellent position to monitor patients between clinic visits and to provide useful information to patients and physicians. T he global prevalence of hypertension, and the associated morbidity and mortality rates, is among the highest for blacks in the United States. 1 Barriers to hypertension control in blacks have been identified at multiple levels, including: patient nonadherence to regimens, 2 suboptimal prescribing, 3-4 and ineffective health systems. 5 A recent review of quality improvement strategies 5 suggests that a team change involving pharmacists may be one of the most effective quality improvement strategies for improving blood pressure (BP) control. However, it is not known whether pharmacy interventions can be implemented successfully in corporately owned pharmacies, where most Americans now obtain their prescriptions. Barriers to Adherence in Black PatientsAlthough nonadherence with antihypertensive regimens is found in all groups, blacks often have higher nonadherence according to objective measures. 6 Studies show that minority populations experience more barriers to adherence, even after controlling for socioeconomic status. For example, blacks are more likely than whites to experience the "core" barriers to adherence, including: problematic side effects, difficulty remembering, doubts or concerns about drug efficacy, and difficulty paying for drugs. 2 Higher priority must be placed on better tools or models of care for detecting and reducing these ...

A constant quest but a difficult goal is replacement of expensive and lengthy engine tests with more cost effective bench tests. This paper will report on development of a bench test, the ROBO, as a potential replacement for the Sequence IIIGA, an oxidative oil thickening engine test now part of ILSAC GF-4 specifications. Sequence IIIGA, a gasoline fueled engine running under severe conditions, is used to condition oils prior to determining TP-1 MRV viscosity, a cold temperature and low shear rate measurement. After Sequence IIIGA conditioning, candidate oils must meet SAE J300 pumpability limits at no more than 5°C warmer than its original SAE W grade. The ROBO bench procedure has been developed to potentially replace Sequence IIIGA engine aging by mimicking, to the degree possible, oxidative conditions found in the engine conditioning procedure. ROBO conditions were developed by employing the three Sequence IIIG ASTM matrix oils and comparing their used oil rheologies from multiple Sequence IIIG and ROBO runs. The results from the final ROBO conditions compare well not only for TP-1 MRV but also for KV 40°C and CCS. To further test the correlation of bench to engine conditioning, a set of diverse oils (various SAE viscosity grades and DI chemistries) have been examined; these viscometric data from ROBO and Sequence IIIG also compare favorably with only a few anomalies. Finally, the status of industry acceptance of ROBO will be discussed.