Impact of a Shared Medical Appointment on Hypertension Clinical Outcomes and Medication Adherence in a Veterans Affairs Health Care System

Abstract

Background:Shared medical appointments (SMAs) are utilized across health care systems to improve access and quality of care, with limited evidence to support the use of SMAs to improve clinical outcomes and medication adherence among hypertensive patients. Objective: Improve access and quality of care provided within a Veterans Affairs health care system via implementation of a hypertension SMA to improve clinical outcomes and medication adherence. Methods: Veterans were eligible for enrollment in the SMA if they received care within the health care system, were aged ≥18 years, were receiving at least 2 antihypertensive medications, and had systolic blood pressure (SBP) >140 mm Hg or diastolic blood pressure (DBP) >90 mm Hg. A pre/post cohort design was used to evaluate the improvement in antihypertensive medication adherence as well as the change in SBP and DBP for all Veterans who attended at least 2 SMAs. Results: Twenty-one Veterans participated in at least 2 SMAs and were included in the analysis; 76.2% had a reduction in SBP with an overall average decrease of −8.3 mm Hg (P = .02). The proportion of Veterans considered to have controlled blood pressure (BP; <140/90 mm Hg) increased from 14.3% at baseline to 42.9% during the SMA period (P = .03). There was no significant difference found for the proportion of Veterans considered adherent to their prescribed antihypertensive medications (95.2% vs 85.7%, respectively; P = .50). Conclusions: SBP significantly improved for patients enrolled in a pharmacist-led SMA at a VA health care system, and the proportion of patients considered to have controlled BP increased significantly.

Moving the Needle on Patient Cancellations Through Mobile Integration

“…Many factors affect veteran no-show rates for appointments: appointment lead time, race, marital status, limited life expectancy, dual psychiatric/ substance abuse diagnosis, and high complexity of VA facilities (Partin et al, 2016). Other factors for nonadherence include lack of knowledge about cRc incidence, being uninformed of risk factors, discomfort from prior colonoscopy procedures, and coordination issues such as travel arrangements for the procedure and taking time off work (Kirk et al, 2017).…”

Long-Term Medication Changes After Hypertension-Focused Lifestyle Medicine Shared Medical Appointment Program

“…In the 180 days following the LMSMA series, eight of the remaining 18 patients (44%) on antihypertensive medication had their dosage reduced or discontinued as part of usual care. The study, like other hypertension-focused SMA research, [6][7][8] investigated only shortterm outcomes.…”