Impact of a pharmacist‐physician collaborative care model on time‐in‐therapeutic blood pressure range in patients with hypertension

Abstract

Introduction Although pharmacist‐physician collaborative care models (PPCCM) improve mean blood pressure (BP) and goal attainment rates, the impact of these models on time‐in‐therapeutic blood pressure range (TTBPR) is unknown. Objectives The primary objective of this study was to determine the effect of a PPCCM on TTBPR compared with a usual care group. Methods This post‐hoc analysis compared data obtained from two retrospective groups of patients with uncontrolled hypertension managed either by a PPCCM or usual care. The primary end point was TTBPR, defined as the proportion of clinic visits with a systolic BP between 120 and 140 mmHg over a 12‐month follow‐up period. Several secondary end points were also evaluated. Means were compared using a t‐test, while counts and comparisons were compared using chi‐square or Fisher exact test. Results The study included 56 patients and 56 controls matched by gender, baseline systolic BP, and history of cardiovascular disease. Mean age was 58 years, 37.5% were female, and 73% were black. The mean TTBPR was 46.2% ± 24.3% in the PPCCM group and 24.8% ± 27.4% in the usual care group (P < 0.0001). Therapeutic inertia was 20.1% in the PPCCM compared with 48.1% in the usual care group (P < 0.0001). Greater reductions in BP were observed in the PPCCM group compared with usual care (systolic BP: −27.8 vs −11.4 mmHg, respectively; P < 0.0001; diastolic BP: −19.2 vs −4.2 mmHg, respectively; P < 0.0001). The BP control rates at 12 months were 89% in the PPCCM compared with 50% in the usual care group (P < 0.0001). Conclusion Patients exposed to a PPCCM had higher TTBPR compared with those who received usual care. The PPCCM group also had a lower rate of therapeutic inertia, greater reductions in BP, and achieved a higher percentage of patients at goal BP in an urban, underserved population.

The cost-effectiveness of pharmacist-physician collaborative care models vs usual care on time in target systolic blood pressure range in patients with hypertension: a payer perspective

“…17,18 Recently, a study conducted by Dixon et al investigated the impact of PPCCM on TTR for systolic BP, as defined by the proportion of clinical encounters with systolic BP between 120 and 140 mmHg during a 12-month follow-up period. 13 The mean TTR for systolic BP was significantly higher among PPCCM patients (46.2% ± 24.3%) than patients who received usual care (24.8% ± 27.4%) (P < 0.0001). 13 Additionally, a majority of patients in the usual care group had a TTR for systolic BP in the lowest quartile (0%-25%), while PPCCM patients were more likely to have TTR for systolic BP in the highest quartile (76%-100%).…”

“…13 The mean TTR for systolic BP was significantly higher among PPCCM patients (46.2% ± 24.3%) than patients who received usual care (24.8% ± 27.4%) (P < 0.0001). 13 Additionally, a majority of patients in the usual care group had a TTR for systolic BP in the lowest quartile (0%-25%), while PPCCM patients were more likely to have TTR for systolic BP in the highest quartile (76%-100%). 13 Despite the available evidence supporting PPCCM as an effective model at improving TTR for systolic BP compared to usual care 13 and that patients with higher TTR for systolic BP have decreased risk of adverse cardiovascular events, [7][8][9] no pharmacoeconomic analysis has combined these findings to model the cost-effectiveness of PPCCM.…”

“…13 Additionally, a majority of patients in the usual care group had a TTR for systolic BP in the lowest quartile (0%-25%), while PPCCM patients were more likely to have TTR for systolic BP in the highest quartile (76%-100%). 13 Despite the available evidence supporting PPCCM as an effective model at improving TTR for systolic BP compared to usual care 13 and that patients with higher TTR for systolic BP have decreased risk of adverse cardiovascular events, [7][8][9] no pharmacoeconomic analysis has combined these findings to model the cost-effectiveness of PPCCM. Therefore, we aimed to compare the cost-effectiveness of PPCCM with usual care on TTR for systolic BP in patients with hypertension.…”

“…[10][11][12] A pharmacist-physician collaborative care model (PPCCM) is a practice model where pharmacists provide medication management for common primary care conditions, often under a collaborative practice agreement with a physician to adjust medications, and order necessary laboratory tests to monitor drug therapy. 13 PPCCMs have been shown to not only be successful within an office-based setting, 13 but even within barbershops and churches. 14,15 A study by Matzke et al found significant improvements (P < 0.01) in hemoglobin, BP, and cholesterol in patients with multiple chronic conditions who were in the PPCCM group compared to those seen by usual care.…”

“…The population studied in this analysis consisted of adult patients who were previously diagnosed with hypertension (defined as office-based BP ≥ 140/90 mmHg) or were receiving antihypertensive medications. 13 A 3-year time horizon was chosen, reflecting the time frame of available data linking TTR for systolic expenditures across all parameter ranges tested in the deterministic sensitivity analysis. For every 10,000 hypertension patients managed with PPCCM vs usual care over a 3-year time horizon, approximately 27 CVD deaths, 29 strokes, 21 nonfatal MIs, and 12 incident HF diagnoses are expected to be averted.…”