Improving Blood Pressure Control Through Pharmacist Interventions: A Meta‐Analysis of Randomized Controlled Trials

Abstract

BackgroundControl of blood pressure (BP) remains a major challenge in primary care. Innovative interventions to improve BP control are therefore needed. By updating and combining data from 2 previous systematic reviews, we assess the effect of pharmacist interventions on BP and identify potential determinants of heterogeneity.Methods and ResultsRandomized controlled trials (RCTs) assessing the effect of pharmacist interventions on BP among outpatients with or without diabetes were identified from MEDLINE, EMBASE, CINAHL, and CENTRAL databases. Weighted mean differences in BP were estimated using random effect models. Prediction intervals (PI) were computed to better express uncertainties in the effect estimates. Thirty‐nine RCTs were included with 14 224 patients. Pharmacist interventions mainly included patient education, feedback to physician, and medication management. Compared with usual care, pharmacist interventions showed greater reduction in systolic BP (−7.6 mm Hg, 95% CI: −9.0 to −6.3; I2=67%) and diastolic BP (−3.9 mm Hg, 95% CI: −5.1 to −2.8; I2=83%). The 95% PI ranged from −13.9 to −1.4 mm Hg for systolic BP and from −9.9 to +2.0 mm Hg for diastolic BP. The effect tended to be larger if the intervention was led by the pharmacist and was done at least monthly.ConclusionsPharmacist interventions – alone or in collaboration with other healthcare professionals – improved BP management. Nevertheless, pharmacist interventions had differential effects on BP, from very large to modest or no effect; and determinants of heterogeneity could not be identified. Determining the most efficient, cost‐effective, and least time‐consuming intervention should be addressed with further research.

Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management

“…In contrast to previously published studies, [25][26][27] this 22-month observational study of a pharmacist collaborative care model implemented in a safety net medical home did not demonstrate differences in trends in BP or glucose control between primary care patients whose hypertension and diabetes were comanaged compared to patients who did not receive such care. PCPs referred to the pharmacist those patients who had poorer disease control at baseline in accordance with protocol recommendations for stratifying patients at high risk for complications.…”

Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management

“…In contrast to previously published studies, [25][26][27] this 22-month observational study of a pharmacist collaborative care model implemented in a safety net medical home did not demonstrate differences in trends in BP or glucose control between primary care patients whose hypertension and diabetes were comanaged compared to patients who did not receive such care. PCPs referred to the pharmacist those patients who had poorer disease control at baseline in accordance with protocol recommendations for stratifying patients at high risk for complications.…”

Impact of a “Pharmacist First” innovative workflow plan in patients with hypertension and/or diabetes

“…The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9…”

“…x EACH demonstrated that a proactive pharmacist approach that allowed patients to spend more time with their pharmacists was much more successful in managing CVD risk factors than usual care. 7 The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9 The P1st model is an implementation strategy that appears to produce results consistent with evidence in the literature that indicates proactive, pharmacist-led interventions are successful in managing CVD and its risk factors.…”

“…7 The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9 The P1st model is an implementation strategy that appears to produce results consistent with evidence in the literature that indicates proactive, pharmacist-led interventions are successful in managing CVD and its risk factors. 7,9,18,19 Indeed, when pharmacists are able to practise to their full scope (assessing patients, prescribing, administering injections, ordering and interpreting laboratory tests and providing disease management), better outcomes have been reported for patients with chronic conditions.…”

Impact of Pharmacist-Led Interventions to Improve Clinical Outcomes for Adults With Type 2 Diabetes at Risk of Developing Cardiovascular Disease: A Systematic Review and Meta-analysis

“…The results revealed that every 1 mmHg elevation in SBP is associated with a 2% increase in the risk of hyperglycaemia 48 and every 10 mmHg reduction in SBP is associated with a 12% CV risk reduction; with the lowest risk occurring at an SBP less than 120 mmHg. 49 Similar to our finding, another systematic review 50 reported a reduction in the diastolic BP by À3.9 mmHg in patients under pharmacist care.…”

Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management

“…In contrast to previously published studies, [25][26][27] this 22-month observational study of a pharmacist collaborative care model implemented in a safety net medical home did not demonstrate differences in trends in BP or glucose control between primary care patients whose hypertension and diabetes were comanaged compared to patients who did not receive such care. PCPs referred to the pharmacist those patients who had poorer disease control at baseline in accordance with protocol recommendations for stratifying patients at high risk for complications.…”

Impact of a “Pharmacist First” innovative workflow plan in patients with hypertension and/or diabetes

“…The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9…”

“…x EACH demonstrated that a proactive pharmacist approach that allowed patients to spend more time with their pharmacists was much more successful in managing CVD risk factors than usual care. 7 The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9 The P1st model is an implementation strategy that appears to produce results consistent with evidence in the literature that indicates proactive, pharmacist-led interventions are successful in managing CVD and its risk factors.…”

“…7 The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9 The P1st model is an implementation strategy that appears to produce results consistent with evidence in the literature that indicates proactive, pharmacist-led interventions are successful in managing CVD and its risk factors. 7,9,18,19 Indeed, when pharmacists are able to practise to their full scope (assessing patients, prescribing, administering injections, ordering and interpreting laboratory tests and providing disease management), better outcomes have been reported for patients with chronic conditions.…”

Impact of Pharmacist-Led Interventions to Improve Clinical Outcomes for Adults With Type 2 Diabetes at Risk of Developing Cardiovascular Disease: A Systematic Review and Meta-analysis

“…The results revealed that every 1 mmHg elevation in SBP is associated with a 2% increase in the risk of hyperglycaemia 48 and every 10 mmHg reduction in SBP is associated with a 12% CV risk reduction; with the lowest risk occurring at an SBP less than 120 mmHg. 49 Similar to our finding, another systematic review 50 reported a reduction in the diastolic BP by À3.9 mmHg in patients under pharmacist care.…”

Clinical Pharmacist Team-Based Care in a Safety Net Medical Home: Facilitators and Barriers to Chronic Care Management

“…In contrast to previously published studies, [25][26][27] this 22-month observational study of a pharmacist collaborative care model implemented in a safety net medical home did not demonstrate differences in trends in BP or glucose control between primary care patients whose hypertension and diabetes were comanaged compared to patients who did not receive such care. PCPs referred to the pharmacist those patients who had poorer disease control at baseline in accordance with protocol recommendations for stratifying patients at high risk for complications.…”

Impact of a “Pharmacist First” innovative workflow plan in patients with hypertension and/or diabetes

“…The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9…”

“…x EACH demonstrated that a proactive pharmacist approach that allowed patients to spend more time with their pharmacists was much more successful in managing CVD risk factors than usual care. 7 The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9 The P1st model is an implementation strategy that appears to produce results consistent with evidence in the literature that indicates proactive, pharmacist-led interventions are successful in managing CVD and its risk factors.…”

“…7 The findings from our study are also consistent with the findings from Santschi et al, 9 who conducted a systematic review of 39 randomized controlled trials and found that pharmacist intervention significantly reduced blood pressure by 7.6/3.9 mmHg compared with usual care. 9 The P1st model is an implementation strategy that appears to produce results consistent with evidence in the literature that indicates proactive, pharmacist-led interventions are successful in managing CVD and its risk factors. 7,9,18,19 Indeed, when pharmacists are able to practise to their full scope (assessing patients, prescribing, administering injections, ordering and interpreting laboratory tests and providing disease management), better outcomes have been reported for patients with chronic conditions.…”

Impact of Pharmacist-Led Interventions to Improve Clinical Outcomes for Adults With Type 2 Diabetes at Risk of Developing Cardiovascular Disease: A Systematic Review and Meta-analysis

“…The results revealed that every 1 mmHg elevation in SBP is associated with a 2% increase in the risk of hyperglycaemia 48 and every 10 mmHg reduction in SBP is associated with a 12% CV risk reduction; with the lowest risk occurring at an SBP less than 120 mmHg. 49 Similar to our finding, another systematic review 50 reported a reduction in the diastolic BP by À3.9 mmHg in patients under pharmacist care.…”