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

Abstract

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.

A systematic review of the role of community pharmacists in the prevention and control of cardiovascular diseases: the perceptions of patients

“… “Missing” “Missing” Strengths Blinding of data analysts Allocation concealment Low inter-rater Pharmacists received program training Minimal group contamination (cluster sampling) Randomisation Limitations Findings limited to chain pharmacies No blinding Smaller sample size Clinical & humanistic (favorable) Okada et al (2017), Japan [ 55 ] CRT, random Hypertensive patients (125) “Missing,” hypertension Lifestyle counseling Self-care management Regular follow-up & monitoring “Missing” “Missing” Strengths Pharmacists received program training Participants received validated BP monitors Minimal group contamination (cluster sampling) Randomization Limitations Patient self-reported data Smaller sample size Differences in groups’ baseline data. Clinical (favourable) & humanistic (unfavorable) Olenak & Calpin (2010), USA [ 56 ] Cross-sectional, convenience Subjects without CHD history (239) “Missing,” metabolic syndrome CVD risk screening Lifestyle counseling Smoking cessation “Missing” Patients perceived community pharmacist’s screening program as satisfactory Strengths Participation not restricted to pharmacy patients Use of point-of-care device Limitations Women-dominated sample Patient self-reported data Convenience sampling Single state Free program might have encouraged participation Clinical & humanistic (favorable) Oser et al (2017), USA [ 57 ] Before-after uncontrolled, purposive Patients on hypertensive medication (534) “Missing,” hypertension Adherence support Regular follow-up & monitoring Lifestyle counseling Referrals Medication management “Missing” “Missing” Strengths Pharmacists received program training All eligible pharmacies were invited to participate Limitations No compara...…”

Gambaran Pelayanan Farmasi Klinik Di Apotek Wilayah Kota Tangerang Selatan Clinical Pharmacy Service at Community Pharmacy in South Tangerang Regency

“…Intervensi yang dilakukan oleh apoteker dalam bentuk konsultasi terhadap pasien dimana apoteker mendiskusikan tentang manajemen pengobatan yang akan dijalani oleh pasien termasuk perubahan gaya hidup. Apoteker juga memberikan kepada pasien beberapa materi yang terkait dengan pengobatan pasien (Carrie et al, 2017).…”

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“…Oser et al describe how the Montana Department of Public Health and Human Services used SPHA-1305 funding to conduct an evaluation of a 3-year intervention among 25 community pharmacies in rural areas to improve adherence to blood pressure medication ( 16 ). In addition to patient-level data, Montana also implemented a statewide survey of pharmacists and identified barriers perceived from the pharmacy point of view.…”