A Randomized Trial of the Effect of Community Pharmacist and Nurse Care on Improving Blood Pressure Management in Patients With Diabetes Mellitus

Abstract

Background: Blood pressure (BP) control in patients with diabetes mellitus is difficult to achieve and current patterns are suboptimal. Given increasing problems with access to primary care physicians, community pharmacists and nurses are well positioned to identify and observe these patients. This study aimed to determine the efficacy of a community-based multidisciplinary intervention on BP control in patients with diabetes mellitus.Methods: We performed a randomized controlled trial in 14 community pharmacies in Edmonton, Alberta, Canada, of patients with diabetes who had BPs higher than 130/80 mm Hg on 2 consecutive visits 2 weeks apart. Care from a pharmacist and nurse team included a wallet card with recorded BP measures, cardiovascular risk reduction education and counseling, a hypertension education pamphlet, referral to the patient's primary care physician for further assessment or management, a 1-page local opinion leader-endorsed evidence summary sent to the physician reinforcing the guideline recommendations for the treatment of hypertension and diabetes, and 4 follow-up visits throughout 6 months. Control-arm patients received a BP wallet card, a pamphlet on diabetes, general diabetes advice, and usual care by their physi-cian. The primary outcome measure was the difference in change in systolic BP between the 2 groups at 6 months.Results: A total of 227 eligible patients were randomized to intervention and control arms between May 5, 2005, and September 1, 2006. The mean (SD) patient age was 64.9 (12.1) years, 59.9% were male, and the mean (SD) baseline systolic/diastolic BP was 141.2 (13.9)/ 77.3 (8.9) mm Hg at baseline. The intervention group had an adjusted mean (SE) greater reduction in systolic BP at 6 months of 5.6 (2.1) mm Hg compared with controls (P =.008). In the subgroup of patients with a systolic BP greater than 160 mm Hg at baseline, BP was reduced by an adjusted mean (SE) of 24.1 (1.9) mm Hg more in intervention patients than in controls (PϽ.001). Conclusion:Even in patients who have diabetes and hypertension that are relatively well controlled, a pharmacist and nurse team-based intervention resulted in a clinically important improvement in BP.

Drug Therapy Monitoring in Patients with Type 2 Diabetes and Hypertension

“…The efficacy of the doctor-pharmacist collaboration studied is consistent with the findings of previous studies on the role of pharmacists in the treatment of DM2, HTN [19][20][21][22] and metabolic syndrome [23]. The results of this study are also consistent with others on the monitoring of HTN [24], DM2 [25] or HTN and DM2.…”

A Cluster Randomized Trial of an Enhanced eGFR Prompt in Chronic Kidney Disease

“…Data are urgently needed to clarify how routinely incorporating information on eGFR into routine care could improve outcomes rather than simply increasing physician workload. Because the effect of treatment recommendations delivered at point of care may be increased by accompanying them with endorsements from respected local physicians (22,36), future use of automated reminders should consider incorporating opinion leaders as signatories or other enabling strategies such as patient activation mechanisms and the involvement of allied health professionals (37).…”

The Enhancing Secondary Prevention in Coronary Artery Disease trial

“…Regardless, our results suggest that faxed evidence reminders to primary care physicians are insufficient on their own to optimize the quality of care for patients with chronic coronary artery disease in the outpatient setting. Some form of stimulus in addition to point-of-care reminders (e.g., patient activation, 28,29 involvement of allied health professionals 34 ) appears to be needed to optimize the care, and hence outcomes, for patients. This article has been peer reviewed.…”