Physician–Pharmacist Collaborative Management

Abstract

Physician-pharmacist collaboration improves blood pressure but there is little information on whether this model can reduce the gap in health care disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate if the pharmacist intervention could reduce health care disparities by improving blood pressure in high risk racial and socioeconomic subjects compared to the control group. The analyses in minority subjects were pre-specified secondary analyses but all other comparisons were secondary, post-hoc analyses. The 9-month visit was completed by 539 patients, 345 received the intervention and 194 were in the control group. Following the intervention, mean systolic blood pressure was 7.3 mm Hg (95%CI= 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared to the control group (p=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% CI=3.2, 13.1) lower than the control group with lower education (p=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. While disparities in blood pressure were reduced by the intervention, there were still non-significant gaps in mean systolic blood pressure when compared to intervention subjects not at risk.

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

“…Findings based on race, income, education, and insurance status were previously published. 38 The pharmacist intervention had similar effects in these subgroups as with the entire study population including those previously taking three or more antihypertensive medications at baseline. 39 As anticipated, a considerable difference in control rates was found between pharmacist intervention and usual care when JNC-7 and JNC-8 BP goals were applied since JNC-8 relaxed goals for DM and CKD.…”

“…27 Additionally, 49% had income less than $25,000/year and 25% used Medicaid, self-pay, or no insurance for their health care payment. 38 Finally, 27% of patients met the definition of treatment-resistant hypertension. 39 The intervention was as effective, or nearly as effective, for all these groups despite the challenges of achieving BP control in these patient groups.…”

Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence

“…In a recent trial involving 32 medical offices in 15 states, a clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. 38 BP was lower at 9 months in both the control and intervention group in all sociodemographic categories when compared with baseline. Over half of the patients were minorities (54.7%), with the majority of those being black (71%) and Hispanic (26%).…”

The state of the science of interprofessional collaborative practice: A scoping review of the patient health-related outcomes based literature published between 2010 and 2018

“…Forty papers were excluded because they were review pieces, 113 papers were not US based, 92 papers did not have patient health-related outcomes, 21 papers did not address interprofessional collaborative practice or interprofessional collaborative care, 54 papers were opinion/commentary or program description papers, 31 papers were duplications, one paper was not peer-reviewed, and three papers were not available from any source. Ultimately, 20 papers [19–38] met the inclusion criteria for review.…”