Impact of a “Pharmacist First” innovative workflow plan in patients with hypertension and/or diabetes

Abstract

Usual community pharmacy workflow, whereby patients might see a pharmacist at the end of the dispensing process, is not conducive to proactive patient-centred care. The objective of this study was to evaluate the impact of the “Pharmacist First” (P1st) workflow model on blood pressure and glycemic control in patients with hypertension and/or diabetes. This retrospective review was set in 2 community pharmacies that use the P1st model in the Greater Edmonton Region. The population entailed patients with hypertension and/or type 1 or 2 diabetes who received care via the P1st workflow model. The P1st workflow model places the patient in immediate contact with the pharmacist. The pharmacist first assesses prescription appropriateness, reviews relevant laboratory tests, discusses chronic disease control and addresses any questions or concerns the patient has before passing the prescription to be filled by a technician. This allows issues or concerns to be identified and addressed up front, rather than waiting until the prescription is filled and the patient is ready to leave the pharmacy. The primary outcome assessed in this study was change in blood pressure and/or A1C from baseline to the last follow-up visit. We reviewed 215 patient records. The mean age was 69.4 years (standard deviation 12.5), 51.2% of patients were male, 57.7% had hypertension, 5.6% had diabetes, and 36.7% had both. Median follow-up time was 4.2 months (interquartile range 2.5 -9.3). In 203 patients with hypertension, systolic blood pressure was reduced from 139.83 mmHg to 131.26 mmHg ( p < 0.001) and diastolic blood pressure from 80.26 mmHg to 76.86 mmHg ( p < 0.001). In 87 patients with diabetes, A1C changed from 7.4% to 7.2% ( p = ns). The P1st workflow model demonstrated significant improvements in blood pressure. Further investigation is needed to evaluate the effectiveness of this model with a control group, longer follow-up and evaluation of the patient experience.

2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension

“…Community pharmacies may also be suitable places to provide health education on hypertension management [1707], which is essential for long-term treatment of largely asymptomatic diseases. In Europe, there are about 160 000 community pharmacies, with an estimated 46 million citizens visiting a pharmacy every day [1708], and available evidence supports a favorable role for them in the detection and control of hypertension and CV risk factors [1709][1710][1711][1712][1713][1714][1715][1716]. Finally, hypertensive patients may be followed by healthcare teams that provide the expertise and cooperation of different medical specialists and other healthcare professionals.…”

Appropriate staffing for pharmacists’ full scope of practice

“…This model of putting the pharmacist at intake has already been piloted and has demonstrated significant improvements in blood pressure. 7 Remember, excellent clinical services = patient retention = increased script count = increased staffing. This is far from resolved, but we must address this elephant in the room.…”