Improving Blood Pressure Control with Physician/Pharmacist Collaboration

Česká verzia

Authors: B. L. Carter
Authors place of work: Division of Clinical and Administrative Pharmacy, College of Pharmacy University of Iowa, Iowa City, Iowa, USA
Published in the journal: Vnitř Lék 2009; 55(4): 389-394
Category:

Summary

Studies have shown that it is very important to control blood pressure in patients with diabetes. Unfortunately, blood pressure control throughout the world is poor. Numerous studies have used interdisciplinary team‑based care to improve the control of many chronic conditions including hypertension and diabetes. This discussion will focus on the results of a study we recently conducted involving clinical pharmacists located in physician offices. The study was a randomized, cluster trial in five clinics. The pharmacists assessed patients with poorly controlled blood pressure and made recommendations to the physicians to change therapy. The patients in control sites received usual care. Blood pressure was controlled in 89% of patients in the intervention group compared to 53% in the control group (p < 0.001). Blood pressure was controlled in 82% of patients with diabetes in the intervention group compared to 24% in the control group (p = 0.002). This was the first study of team‑based care that used ambulatory BP monitoring. Ambulatory blood pressure was reduced significantly more in the intervention group compared to the control group. The primary reason for the superior results in the intervention group was more intensive use of medications to control blood pressure. This study demonstrates that blood pressure can be controlled in a high number of patients with diabetes following our physician/pharmacist collaborative model.

Key words:
hypertension – blood pressure control – diabetes mellitus – physician – pharmacist

Zdroje

1. Carter BL, Zillich AJ, Elliott WJ. How pharmacists can assist physicians with controlling blood pressure. J Clin Hypertens (Greenwich) 2003; 5: 31–37.

2. Park JJ, Kelly P, Carter BL et al. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc (Wash) 1996; NS36: 443–451.

3. Mehos BM, Saseen JJ, MacLaughlin EJ. Effect of pharmacist intervention and initiation of home blood pressure monitoring in patients with uncontrolled hypertension. Pharmacotherapy 2000; 20: 1384–1389.

4. McKenney JM, Slining JM, Henderson HR et al. The effect of clinical pharmacy services on patients with essential hypertension. Circulation 1973; 48: 1104–1111.

5. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. JAMA 2006; 297: 2563–2571.

6. Von Muenster SJ, Carter BL, Weber CA et al. Description of pharmacist interventions during physician-pharmacist co-management of hypertension. Pharm World Sci 2008; 30: 128–135.

7. Ellis SL, Carter BL, Malone DC et al. Clinical and economic impact of ambulatory care clinical pharmacists in management of dyslipidemia in older adults: the IMPROVE study. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers. Pharmacotherapy 2000; 20: 1508–1516.

8. Tsuyuki RT, Johnson JA, Teo KK et al. A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med 2002; 162: 1149–1155.

9. Zarowitz BJ, Aronow WS, Hollenack K et al. The application of evidence‑based principles of care in older persons (issue 2): management of lipid disorders. J Am Med Dir Assoc 2006; 7: 173–179.

10. Olson KL, Rasmussen J, Sandhoff BG et al. Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization. Arch Intern Med 2005; 165: 49–54.

11. Merenich JA, Olson KL, Delate T et al. Mortality reduction benefits of a comprehensive cardiac care program for patients with occlusive coronary artery disease. Pharmacotherapy 2007; 27: 1370–1378.

12. Saini B, Smith L, Armour C et al. An educational intervention to train community pharmacists in providing specialized asthma care. Am J Pharm Educ 2006; 70: 118.

13. Pauley TR, Magee MJ, Cury JD. Pharmacist-managed, physician-directed asthma management program reduces emergency department visits. Ann Pharmacother 1995; 29: 5–9.

14. Rothman RL, Malone R, Bryant B et al. A randomized trial of a primary care‑based disease management program to improve cardiovascular risk factors and glycated hemoglobin levels in patients with diabetes. Am J Med 2005; 118: 276–284.

15. Ragucci KR, Fermo JD, Wessell AM et al. Effectiveness of pharmacist-administered diabetes mellitus education and management services. Pharmacotherapy 2005; 25: 1809–1816.

16. Tillman DJ, Charland SL, Witt DM. Effectiveness and economic impact associated with a program for outpatient management of acute deep vein thrombosis in a group model health maintenance organization. Arch Intern Med 2000; 160: 2926–2932.

17. Wilt VM, Gums JG, Ahmed OI et al. Outcome analysis of a pharmacist-managed anticoagulation service. Pharmacotherapy 1995; 15: 732–739.

18. Witt DM, Sadler MA, Shanahan RL et al. Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 2005; 127: 1515–1522.

19. American Diabetes Association. Standards of medical care in diabetes – 2008. Diabetes Care 2008; 31 (Suppl 1): S12–S54.

20. ACCORD News Conference press kit.http://www.nhlbi.nih.gov/health/prof/heart/other/accord/

21. Chobanian AV, Bakris GL, Black HR et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

22. European Society of Hypertension-European Society of Cardiologiy Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

23. World Health Report 2002: Reducing risks, promoting healthy life. Geneva, Switzerland: World Health Organization 2002. Avaible from: http://www.who.int/whr/2002/.

24. Chobanian AV, Bakris GL, Black HR et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003; 42: 1206–1252.

25. Garg JP, Elliott WJ, Folker A et al. Resistant hypertension revisited: a comparison of two university‑based cohorts. Am J Hypertens 2005; 18: 619–626.

26. Berlowitz DR, Ash AS, Hickey EC et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339: 1957–1963.

27. Oliveria SA, Lapuerta P, McCarthy BD et al. Physician‑related barriers to the effective management of uncontrolled hypertension. Arch Intern Med 2002; 162: 413–420.

28. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med 2001; 345: 479–486.

29. Milchak JL, Carter BL, James PA et al. Measuring adherence to practice guidelines for the management of hypertension: an evaluation of the literature. Hypertension 2004; 44: 602–608.

30. Carter BL, Malone DC, Ellis SL et al. Antihypertensive Drug Utilization in Hypertensive Veterans With Complex Medication Profiles. J Clin Hypertens (Greenwich) 2000; 2: 172–180.

31. Hill MN, Levine DM, Whelton PK. Awareness, use, and impact of the 1984 Joint National Committee consensus report on high blood pressure. Am J Public Health 1988; 78: 1190–1194.

32. Naiman DJ, Barker LR. Adherence to the JNC VI guidelines for the treatment of hypertension in the resident clinic. Md Med J 1999; 48: 307–311.

33. Nelson CR, Knapp DA. Trends in antihypertensive drug therapy of ambulatory patients by US office‑based physicians. Hypertension 2000; 36: 600–603.

34. Ong KL, Cheung BM, Man YB et al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007; 49: 69–75.

35. Walsh JM, McDonald KM, Shojania KG et al. Quality improvement strategies for hypertension management: a systematic review. Med Care 2006; 44: 646–657.

36. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225–1230.

37. Battersby MW. Health reform through coordinated care: SA HealthPlus. BMJ 2005; 330: 662–665.

38. Wilson T, Buck D, Ham C. Rising to the challenge: will the NHS support people with long term conditions? BMJ 2005; 330: 657–661.

39. Avery AJ, Pringle M. Extended prescri-bing by UK nurses and pharmacists. BMJ 2005; 331: 1154–1155.

40. Carter BL, Zillich AJ, Elliott WJ. How pharmacists can assist physicians with controlling blood pressure. J Clin Hypertens (Greenwich) 2003; 5: 31–37.

41. Bogden PE, Abbott RD, Williamson P et al. Comparing standard care with a physician and pharmacist team approach for uncontrolled hypertension. J Gen Intern Med 1998; 13: 740–745.

42. Bond CA, Monson R. Sustained improvement in drug documentation, compliance, and disease control. A four-year analysis of an ambulatory care model. Arch Intern Med 1984; 144: 1159–1162.

43. Borenstein JE, Graber G, Saltiel E et al. Physician-pharmacist comanagement of hypertension: a randomized, comparative trial. Pharmacotherapy 2003; 23: 209–216.

44. Bogden PE, Koontz LM, Williamson P et al. The physician and pharmacist team. An effective approach to cholesterol reduction. J Gen Intern Med 1997; 12: 158–164.

45. Carter BL, Barnette DJ, Chrischilles E et al. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy 1997; 17: 1274–1285.

46. Erickson SR, Slaughter R, Halapy H. Pharmacists’ ability to influence outcomes of hypertension therapy. Pharmacotherapy 1997; 17: 140–147.

47. Hawkins DW, Fiedler FP, Douglas HL et al. Evaluation of a clinical pharmacist in caring for hypertensive and diabetic patients. Am J Hosp Pharm 1979; 36: 1321–1325.

48. Kaboli PJ, Hoth A, Carter BL et al. The VA Enhanced Pharmacy Outpatient Clinic (EPOC) Study: A randomized-controlled pharmacist-physician intervention trial. J Gen Intern Med 2004; 19: 227 (Abstract).

49. Wright JT jr, Bakris G, Greene T et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002; 288: 2421–2431.

50. Pickering TG, Hall JE, Appel LJ et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005; 45: 142–161.

51. Carter BL, Helling DK. Ambulatory care pharmacy services: has the agenda changed? Ann Pharmacother 2000; 34: 772–787.