An Unmet Need Meets an Untapped Resource: Pharmacist-Led Pathways for Hypertension Management for Emergency Department Patients

Stewart, Brittany; Brody, Aaron; Krishnan, Abhinav C.; Brown, Sara; Levy, Phillip D.

doi:10.1007/s11906-019-0965-4

Cited by 3 publications

(4 citation statements)

References 40 publications

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“…The CDC encourages advancing team-based care through CPAs to improve outcomes for chronic disease state management such as HTN. 21 While there are several published pharmacist-physician collaborative models for HTN management in a variety of pharmacy settings, 22 to our knowledge, this is the first study to evaluate a model with an outpatient pharmacist in collaboration with ED physicians. Although we did not measure the impact on ED visits or primary care establishment following the study intervention, this would be beneficial to evaluate in the future.…”

Section: Discussionmentioning

confidence: 99%

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study

et al. 2021

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Background: The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. Methods: This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. Results: There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). Conclusion: The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.

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Section: Discussionmentioning

confidence: 99%

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study

et al. 2021

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“…42 Despite these conflicting data, we can still say that the pharmacist plays a critical role in managing blood pressure. 40,41,[43][44][45][46][47] However, regarding pharmacist-led intervention, an extension of duration can be essential to improve blood pressure control. Therefore, as evidenced by our study, the most reasonable approach would be to adopt pharmacist-physician collaboration and interventions to achieve effective patient care.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of pharmacist-led and pharmacist-physician intervention on blood pressure control

Memişoğlu

Çelik

2021

Ital J Med

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Effective intervention is a significant component in the improvement of blood pressure control and patient adherence. Blood pressure control includes different self-monitoring techniques, mobile health monitoring, or healthcare professionals’ interventions. This study aims to compare, analyze, and interpret the effectiveness of pharmacist-physician collaboration and pharmacist- led interventions. Meta-analysis was performed using MEDLINE via PubMed, EMBASE, EBSCO, Web of Science, Scopus, and the Cochrane Library databases between 2008-2018. Of the 51 relevant systematic reviews identified, 15 were of sufficient quality and included in the data synthesis. The breakdown of the 15 included 7 (n=2026) pharmacist and 8 pharmacist-physician interventions (n=2361). The impact of pharmacist-physician collaboration and pharmacist-led interventions on Systolic Blood Pressure was –8.22 (–11.01; –5.42) (P<0.01) and –7.68 (–9.30; –6.06) (P=0.35), respectively. On the other hand, similar correlation for Diastolic Blood Pressure for the impact of pharmacist-physician collaboration and pharmacist-led interventions was –3.55 (–4.54; –2.55) (P=0.49) and –2.58 (–3.76; –1.39) (P=0.24), respectively. These results suggest that both interventions are effective for blood pressure control. However, when two meta-analyses were compared, it was found that pharmacist-physician collaboration was more effective than pharmacist-led interventions. This finding highlights the importance of multidisciplinary approaches during blood pressure control procedures. When a holistic view is considered; especially cost-effectiveness, future studies must be diversified to encompass a broader context and impact analysis.

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Section: Optimizing Transitions Of Carementioning

confidence: 99%

“…For patients with asymptomatic elevated BP presenting to the ED, engaging community health workers, implementing specific care pathways, and providing referral strategies, including harnessing alternative care models to facilitate primary care follow-up and ongoing BP management, are critical to ensuring appropriate and equitable management after ED discharge. [34][35][36][37][38][39][40] In addition to the immediate clinical needs, significant economic challenges, educational challenges, and geographic disparities play a pivotal role and disproportionally affect people of color. Particularly critical are equity issues related to inconsistent access to longitudinal primary care.…”

Section: Optimizing Transitions Of Care Disposition After An Ed Encou...mentioning

confidence: 99%

The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association

Bress,

Anderson,

Flack

et al. 2024

Hypertension

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Over the past 3 decades, a substantial body of high-quality evidence has guided the diagnosis and management of elevated blood pressure (BP) in the outpatient setting. In contrast, there is a lack of comparable evidence for guiding the management of elevated BP in the acute care setting, resulting in significant practice variation. Throughout this scientific statement, we use the terms acute care and inpatient to refer to care received in the emergency department and after admission to the hospital. Elevated inpatient BP is common and can manifest either as asymptomatic or with signs of new or worsening target-organ damage, a condition referred to as hypertensive emergency. Hypertensive emergency involves acute target-organ damage and should be treated swiftly, usually with intravenous antihypertensive medications, in a closely monitored setting. However, the risk-benefit ratio of initiating or intensifying antihypertensive medications for asymptomatic elevated inpatient BP is less clear. Despite this ambiguity, clinicians prescribe oral or intravenous antihypertensive medications in approximately one-third of cases of asymptomatic elevated inpatient BP. Recent observational studies have suggested potential harms associated with treating asymptomatic elevated inpatient BP, which brings current practice into question. Despite the ubiquity of elevated inpatient BPs, few position papers, guidelines, or consensus statements have focused on improving BP management in the acute care setting. Therefore, this scientific statement aims to synthesize the available evidence, provide suggestions for best practice based on the available evidence, identify evidence-based gaps in managing elevated inpatient BP (asymptomatic and hypertensive emergency), and highlight areas requiring further research.

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An Unmet Need Meets an Untapped Resource: Pharmacist-Led Pathways for Hypertension Management for Emergency Department Patients

Cited by 3 publications

References 40 publications

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study

Meta-analysis of pharmacist-led and pharmacist-physician intervention on blood pressure control

The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association

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