A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial)

Stewart, Kay; George, Johnson; Namara, Kevin P. Mc; Jackson, Shane; Peterson, Gregory M.; Bereznicki, Lre; Gee, Peter; Hughes, Jeffery; Bailey, Michael; Hsueh, Ys. A.; McDowell, Jennifer Mary; Bortoletto, Diana A; Lau, Rosalind

doi:10.1111/jcpt.12185

Cited by 84 publications

(98 citation statements)

References 33 publications

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“…Multilevel implementation strategies without team-base care commonly consist of health coaching, home BP monitoring, and/or provider training (38,39). In some multilevel intervention trials, pharmacists conducted medication titration, health coaching, and/or home BP monitoring independent of the primary care team (40). Clearly, multilevel, multicomponent strategies, combining team-based care, health coaching, home BP monitoring, and provider training, have been proven to be the most effective strategy for BP control among patients with hypertension.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients

et al. 2017

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Background The prevalence of hypertension is high and increasing worldwide while the proportion of controlled hypertension is low. Purpose To assess the comparative effectiveness of 8 implementation strategies for blood pressure (BP) control in adults with hypertension. Data Sources Systematic searches of MEDLINE and Embase from inception to September 2017 with no language restriction supplemented with manual reference searches. Study Selection Randomized controlled trials lasting at least 6 months comparing implementation strategies versus usual care on BP reduction in adults with hypertension. Data Extraction Two investigators independently extracted trial data. Trials were grouped by implementation strategy, and BP reduction effects were compared using multivariate-adjusted generalized estimating equations. A modified Cochrane Risk of Bias tool was used for trial quality assessment. Data Synthesis A total of 121 comparisons from 100 articles with 55,920 hypertensive patients were included. Multilevel, multicomponent strategies, such as team-based care with medication titration by non-physician [−7.1 mmHg (95% CI: −8.9, −5.2)], team-based care with medication titration by physician [−6.2 mmHg (−8.1, −4.2)], and multilevel strategies without team-based care [−5.0 mmHg (−8.0, −2.0)] were most effective for systolic BP reduction. Patient-level strategies also resulted in significant systolic BP reductions of −3.9 mmHg (−5.4, −2.3) for health coaching and −2.7 mmHg (−3.6, −1.7) for home BP monitoring. Similar trends were observed for diastolic BP reduction. Provider training was tested in few trials and resulted in non-significant BP reduction. Limitations Sparse data from low- and middle-income countries, few trials of some implementation strategies, and possible publication bias. Conclusions Multilevel, multicomponent strategies, followed by patient-level strategies, are most effective for BP control in patients with hypertension and ought to be used to improve hypertension control. Primary Funding Source US National Institutes of Health

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients

et al. 2017

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“…For example, there were a substantial number of patients who did not complete the study and follow‐up. This rate is comparable to other intervention trials which analyzed adherence outcome for various chronic diseases, and to the rates reported for lipid‐lowering interventional trials, and a multiple imputation analysis was used to take into account the uncertainty of the imputed values. It may be worth considering that if participating health professionals had received reimbursement, they may have provided better patient recruitment and the number of dropouts could be reduced .…”

Section: Discussionmentioning

confidence: 52%

Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial

Oñatibia-Astibia

Malet-Larrea

Larrañaga

et al. 2019

Health Services Research

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Objective To evaluate the impact of health professionals’ intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. Study Setting Forty‐six community pharmacies and 50 primary care centers of Spain. Study Design Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention‐to‐treat (ITT) analysis was performed with multiple imputation to replace the missing data. Data Collection Adherence, total cholesterol levels, and lifestyle behaviors. Findings The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30‐1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81‐3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). Conclusions The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.

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“…The project components in these previous studies were not identical to those in TUPD, however. Some of those interventions provided resources such as a take-home tool kit (4) or blood pressure cuffs for self-monitoring at home (5,7,8) that our project did not provide.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacists can help identify and overcome barriers (eg, financial difficulties, side effects) that health care providers may not detect during patient visits, which often are infrequent. Pharmacies also can assist patients in managing their blood pressure levels (3,7). …”

Section: Introductionmentioning

confidence: 99%

A Project to Promote Adherence to Blood Pressure Medication Among People Who Use Community Pharmacies in Rural Montana, 2014–2016

2017

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IntroductionPharmacists can assist patients in managing their blood pressure levels. We assessed whether adherence to blood pressure medication improved among people who used community pharmacies in rural Montana after pharmacists initiated consultations and distributed educational materials developed for the Million Hearts Initiative’s “Team Up. Pressure Down.” (TUPD) program.MethodsFrom 2014 to 2016, the Cardiovascular Health Program at the Montana Department of Public Health and Human Services conducted a statewide project to evaluate an intervention for adherence to blood pressure medication administered through community pharmacies. After the year 1 pilot, we redesigned the program for year 2 and year 3 and measured the percentage of participating patients who adhered to blood pressure medication. We also conducted a statewide survey to assess pharmacy characteristics, computer-system capabilities, and types of consulting services provided by pharmacists.ResultsTwenty-five community pharmacies completed Montana’s TUPD program: 8 pharmacies in the pilot year, 11 pharmacies in year 2, and 6 pharmacies in year 3. For year 2 and year 3 combined, the percentage of participating patients who achieved blood pressure medication adherence improved preintervention to postintervention from 73% to 89%, and adherence improved in 15 of the 17 pharmacies. The pilot pharmacies identified 3 major barriers to project success: patient buy-in, staff burden in implementing the project, and funding. In the statewide assessment, TUPD-funded pharmacies were significantly more likely than non-TUPD–funded pharmacies to provide prescription synchronization and medication management with feedback to the patient’s physician.ConclusionCommunity pharmacies in rural areas can effectively use brief consultations and standard educational materials to improve adherence to blood pressure medication.

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A multifaceted pharmacist intervention to improve antihypertensive adherence: a cluster-randomized, controlled trial (HAPPy trial)

Abstract: This community pharmacist intervention resulted in improved adherence to antihypertensive medication and reduced systolic BP.

Cited by 84 publications

References 33 publications

Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients

Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients

Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial

A Project to Promote Adherence to Blood Pressure Medication Among People Who Use Community Pharmacies in Rural Montana, 2014–2016

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