A Mixed‐Method Approach to Evaluate a Pharmacist Intervention for Veterans With Hypertension

Parker, Christopher P.; Cunningham, Cassie; Carter, Barry L.; Weg, Mark W. Vander; Richardson, Kelly; Rosenthal, Gary E.

doi:10.1111/jch.12250

Cited by 14 publications

(15 citation statements)

References 32 publications

(29 reference statements)

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“…Mean BP and BP control was similar in both the group that had the intervention continued for an additional 24 months and in the group receiving the one‐time educational intervention. As previously reported, patients who were involved in the intervention had high levels of satisfaction …”

Section: Discussionsupporting

confidence: 64%

“…All enrolled patients received the study intervention for 6 months . This included structured visits with the pharmacist at baseline and 1, 2, 4, and 6 months and telephone calls at 2 weeks and between the in‐person visits as needed.…”

Section: Methodsmentioning

confidence: 99%

“…Many of these participants' BP had been poorly controlled for long periods. All patients received a pharmacist intervention for 6 months . In order to determine whether the intervention could be sustained, patients were then randomized to continue or discontinue the intervention.…”

mentioning

confidence: 99%

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Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans

Carter

Weg

Parker³

et al. 2015

J of Clinical Hypertension

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Clinical pharmacists are utilized in Veterans Health Administration (VHA) facilities to assist with management of patients with chronic conditions including hypertension. The goal of this study was to examine blood pressure (BP) control after discontinuation of an intensive pharmacistmanaged intervention. The study was conducted at a single Midwest VHA medical center and two affiliated communitybased outpatient clinics. Patients with uncontrolled BP received an intensive pharmacist intervention for the first 6 months. Patients were then stratified based on whether their BP was controlled or not and were randomized to either continue the intervention for another 24 months (30 month total time period) or the intervention was discontinued following one-time receipt of educational materials. Mean systolic and diastolic BPs were reduced (P<.001) in diabetic patients (8.0AE14.4 mm Hg and 4.0AE9.1 mm Hg, respectively) and in nondiabetic patients (14.0AE16.4 mm Hg and 5.0AE10.0 mm Hg, respectively) following the 6-month intervention, with 54% of the total sample achieving BP control. BP control and the reduction in mean BP was maintained to a similar degree in both study groups at 12, 18, 24, and 30 months. There were no significant differences in BP at any of the follow-up periods in patients who did and did not receive the continued pharmacist intervention. This study found that BP control was maintained for at least 24 months following discontinuation of an intensive pharmacist intervention. These findings were seen in both the group that had a continued pharmacist intervention and in the group that had a one-time educational session when the intervention was discontinued. This study suggests that once BP control is achieved following a pharmacist intervention, patients can be referred back to their primary care provider for continued follow-up. J Clin Hypertens (Greenwich). 2015;17:701-708. ª 2015 Wiley Periodicals, Inc.Team-based care strategies have emerged as an effective approach for managing hypertension and other chronic conditions.1-4 For example, the Community Preventive Services Task Force recently evaluated 44 studies of team-based care (median intervention duration of 12 months) and found a mean difference of À5.4 mm Hg in systolic blood pressure (SBP), 5 while a previous systematic review found a mean difference of À9.7 mm Hg when compared with usual care. 6 The former systematic review found higher blood pressure (BP) control rates with pharmacists compared with the addition of other professionals. This finding was confirmed by another systematic review that found that nurses and pharmacists were effective in improving BP but that the effect of pharmacists was greater, with 9 mm Hg vs 5 mm Hg reductions, respectively. 7Based on this and other evidence, hypertension guidelines developed by the Veterans Health Administration (VHA) and the Department of Defense recommend the use of team-based strategies involving pharmacists to improve BP control in patients with resistant hypertention.8 While studies have...

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Section: Discussionsupporting

confidence: 64%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans

Carter

Weg

Parker³

et al. 2015

J of Clinical Hypertension

Self Cite

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“…27,36 Importantly, previous work has demonstrated that patients, pharmacists and physicians express positive attitudes towards future implementations of PPCM interventions, regardless of whether they have had previous experience with such models. 37,38 Primary care providers also appear to be accepting of these models once in place, with ~95% of providers considering at least 1 of their patients appropriate for such interventions. 39 Moreover, once engaged in these models, physicians tend to have a very high (95%) level of agreement with pharmacist recommendations, especially when the clinical pharmacist is housed within the same clinic.…”

Section: Discussionmentioning

confidence: 99%

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

Smith

Carris

Dietrich

et al. 2016

Journal of the American Society of Hypertension

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Team-based care has been recommended for patients with treatment-resistant hypertension (TRH), but its efficacy in this setting is unknown. We compared a physician-pharmacist collaborative model (PPCM) to usual care in patients with TRH participating in the Collaboration Among Pharmacists and physicians To Improve Outcomes Now (CAPTION) study. At baseline, 169 patients (27% of CAPTION patients) had TRH: 111 received the PPCM intervention and 58 received usual care. Baseline characteristics were similar between treatment arms. After 9 months, adjusted mean systolic BP was reduced by 7 mmHg more with PPCM intervention than usual care (p=0.036). BP control was 34.2% with PPCM versus 25.9% with usual care (adjusted OR, 1.92; 95% CI, 0.33–11.2). These findings suggest that team-based care in the primary care setting may be effective for TRH. Additional research is needed regarding the long-term impact of these models and to identify patients most likely to benefit from team-based interventions.

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“…Under the physician-pharmacist collaborative management (PPCM) model, the physician-pharmacist relationship allows the pharmacist to assume responsibilities as delegated by the PCP. One of us (BLC) has extensively evaluated this model to improve BP control in several studies [7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Summative Evaluation of Physician-Pharmacist Collaboration Management

Finkelstein¹,

Blaine²

2016

J Hypertens (Los Angel)

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A Mixed‐Method Approach to Evaluate a Pharmacist Intervention for Veterans With Hypertension

Cited by 14 publications

References 32 publications

Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans

Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans

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

Summative Evaluation of Physician-Pharmacist Collaboration Management

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