Evaluation of Pharmacist Care for Hypertension in the Veterans Affairs Patient-centered Medical Home: A Retrospective Case-control Study

Abstract

Background and Purpose:We examined blood pressure 1 year after stroke discharge and its association with treatment intensification. Methods:We examined the systolic blood pressure (SBP) stratified by discharge SBP (<140; 141 to 160; or >160 mmHg) among a national cohort of Veterans discharged after acute ischemic stroke. Hypertension treatment opportunities were defined as outpatient SBP >160 mm Hg or repeated SBPs >140 mm Hg. Treatment intensification was defined as the proportion of treatment opportunities with antihypertensive changes (range 0 to 100%, where 100% indicates that each elevated SBP always resulted in medication change).Results: Among 3153 ischemic stroke patients, 38% had at least one elevated outpatient SBP eligible for treatment intensification in the 1 year post stroke. Thirty percent of patients had a discharge SBP <140mmHg; and an average 1.93 treatment opportunities and treatment intensification occurred in 58% of eligible visits. Forty seven percent of patients discharged with SBP 141 to160 mmHg had an average of 2.1 opportunities for intensification and treatment intensification occurred in 60% of visits. Sixty three percent of the patients discharged with an SBP >160mmHg had an average of 2.4 intensification opportunities, and treatment intensification occurred in 65% of visits. Conclusion:Patients with discharge SBP >160mmHg had numerous opportunities to improve hypertension control. Secondary stroke prevention efforts should focus on: initiation and review of antihypertensives prior to acute stroke discharge; management of antihypertensives and titration; and patient medication adherence counseling.

Management of hypertension in an Australian community pharmacy setting – patients’ beliefs and perspectives

“…[9] Evidence from studies exploring the role of pharmacists in disease management highlight that pharmacist-led services can improve patients' self-management, treatment adherence, clinical outcomes [10,11] and appropriateness of prescribing. [16] There is a need to more fully utilise pharmacists' expertise and accessibility, working towards the provision of team-based approaches to patient care. [16] There is a need to more fully utilise pharmacists' expertise and accessibility, working towards the provision of team-based approaches to patient care.…”

“…[12][13][14][15] However, few services are explicitly multifaceted, targeting both the patient's adherence and the clinician's prescribing. [16] There is a need to more fully utilise pharmacists' expertise and accessibility, working towards the provision of team-based approaches to patient care. [17] Therefore, the aim of this study was to explore patients' perspectives following a trial of a pharmacist-led multifaceted service in hypertension management.…”

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“…Previous studies have demonstrated that pharmacists are well suited to provide support, able to create effective relationships with providers and achieve high provider acceptance of pharmacist recommendations [24,25]. Furthermore, pharmacists have successful providers in patient-centered medical homes [26] and have provided care with demonstrated improved patient outcomes [27][28][29].…”

Exploring future models of primary care for Texas

“…For patients in the program, diastolic blood pressure decreased from baseline by À2.5 and À3.2 mmHg at 6 and 12 months, respectively, whereas controls had a diastolic blood pressure decrease from baseline by À1.1 and À1.2 mmHg at 6 and 12 months. Ultimately, patients who were referred to the pharmacist hypertension care management program had a significant improvement in blood pressure and indicated that this may be an effective method of improving blood pressure control among veterans in the patient-centered medical home model (Zillich et al, 2015).…”