Pharmacist intervention for blood pressure control: medication intensification and adherence

Abstract

Objective To describe medication adherence and medication intensification in a physician-pharmacist collaborative management (PPCM) model compared to usual care. Design Prospective, cluster, randomized study in 32 primary care offices from 15 states. The primary outcomes were medication adherence and anti-hypertensive medication changes during the first nine months of the intervention. The nine month visit was completed by 539 patients, 345 of which received the intervention. Results There was no significant difference between intervention and usual care patients in regards to medication adherence at 9 months. Intervention patients received significantly more medication changes (4.9 vs.1.1; p=0.0003) and had significantly increased use of diuretics and aldosterone antagonists when compared to usual care (p=0.01). Conclusions The PPCM model increased medication intensification, however no significant change in medication adherence was detected. PPCM models will need to develop non-adherence identification and intervention methods to further improve the potency of the care team.

Pharmacist Intervention for Blood Pressure Control in Patients with Diabetes and/or Chronic Kidney Disease

“…37 There were no differences in medication classes used between intervention and control groups following the intervention with the exception that there was greater use of diuretics and aldosterone antagonists in the intervention group.…”

“…There were significantly more medication changes (4.9 ± 5.1 vs 1.1 ± 1.6, p=0.0003) and medications added or doses increased (3.2 ±3.2 vs 0.7 ± 1.1, p=0.0002) in the intervention group compared to the control group, respectively. 37 The intervention group was treated with significantly more diuretics and aldosterone antagonists, the latter likely being used for patients with treatment-resistant hypertension.…”

Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension

“…Another likely contributor to the overall reduction in mean BP was reduced clinical inertia as evidenced by more frequent follow-up, which has been linked with greater BP control, 29,30 and a greater number of antihypertensive regimen modifications in the PPCM intervention arms. 31 Finally, greater reinforcement of lifestyle modifications and dietary salt restriction in the PPCM intervention groups may also have played a role, although the extent to which these recommendations were made in usual care clinics is not known.…”

Cost-Effectiveness of a Physician–Pharmacist Collaboration Intervention to Improve Blood Pressure Control

“…(28) The remaining intervention included a telephone call from the pharmacist at 2 weeks, structured face-to-face visits between patients and pharmacists at baseline, 1, 2, 4, 6 and 8 months, and additional visits if BP remained uncontrolled. This implementation trial did not require strict adherence to this protocol, but all pharmacist visits were tracked.…”