Physician‐Pharmacist Comanagement of Hypertension: A Randomized, Comparative Trial

Borenstein, Jeff; Graber, Geneen R.; Saltiel, Emmanuel; Wallace, Joel; Ryu, Seon-Young; Jackson, Archi; Deutsch, Stephen I.; Weingarten, Scott

doi:10.1592/phco.23.2.209.32096

Cited by 172 publications

(167 citation statements)

References 41 publications

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“…Randomized clinical trials have demonstrated that non-physician clinicians are more effective at bringing hypertensive individuals in concordance with national guideline goals (41)(42)(43)(44)(45). One mechanism for the success of nurses in improving BP control relates to their training to address non-pharmacological interventions.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Bosworth

Olsen

Neary

et al. 2008

Patient Education and Counseling

140

124

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Objectives-Evaluating a randomized controlled trial involving a tailored behavioral intervention conducted to improve blood pressure control.Methods-Adults with hypertension from two outpatient primary care clinics were randomly allocated to receive a nurse-administered behavioral intervention or usual care. In this ongoing study, patients receive the tailored behavioral intervention bi-monthly for two years via telephone; the goal of the intervention is to promote medication adherence and improve hypertension-related health behaviors. Patient factors targeted in the tailored behavioral intervention include perceived risk of hypertension and knowledge, memory, medical and social support, patients' relationship with their health care provider, adverse effects of medication therapy, weight management, exercise, diet, stress, smoking, and alcohol use.Results-The sample randomized to the behavioral intervention consisted of 319 adults with hypertension (average age = 60.5 years; 47% African-American). A comparable sample of adults was assigned to usual care (n=317). We had a 96% retention rate for the overall sample for the first 6 months of the study (93% at 12 months). The average phone call has lasted 18 minutes (range 2 to 51 minutes). From baseline to six months, self-reported medication adherence increased by 9% in the behavioral group vs. 1% in the non-behavioral group.Conclusion-The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Practice Implications-Despite knowledge of the risks and acceptable evidence, a large number of hypertensive adults still do not have their blood pressure under effective control. This study will be an important step in evaluating a tailored multibehavioral intervention focusing on improving blood pressure control. NIH Public Access

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Section: Theoretical Frameworkmentioning

confidence: 99%

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Bosworth

Olsen

Neary

et al. 2008

Patient Education and Counseling

140

124

View full text Add to dashboard Cite

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“…S tudies have shown that pharmacist consultation programs can improve clinical outcomes by optimizing medication use in ambulatory patients. [1][2][3][4][5] Among patients in a heart failure clinic, a program of pharmacist evaluation (medication evaluation and recommendations, patient education and followup telemonitoring) resulted in a significant decrease in heart failure events and all-cause mortality. Study authors attributed this result to closer follow-up and optimizing doses of angiotensinconverting enzyme (ACE) inhibitors.…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

“…1 In 2 randomized trials of patients with hypertension, those who were treated collaboratively by physicians and pharmacists achieved better control of blood pressure than did those who were managed by the physician alone. 2,3 The physician-pharmacist team in 1 study increased medication optimization by titrating doses more effectively, switching to less expensive or more appropriate formulations of medications, and increasing appropriate laboratory monitoring. 2 Even when patients' medications were not changed, blood pressures were still improved.…”

Section: What Is Already Known About This Subjectmentioning

confidence: 99%

“…1,3,30,33 The IMPROVE study excluded patients who had a psychiatric illness requiring mental health services, poor understanding of written and spoken English, visual impairment and residence far from the physician office, or no working telephone. 19 The only ability required for patients in the current study was ability to physically make it to a physician office visit; there were no other limits.…”

Section: Subtherapeutic Dosementioning

confidence: 99%

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A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Altavela¹,

Jones²,

Ritter³

2008

JMCP

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BACKGROUND: There is evidence that pharmacist interventions improve clinical outcomes. The few studies that address economic outcomes (a) often report estimated instead of actual medical costs, (b) report only medication costs, or (c) have been conducted in settings that are not typical of community-based primary care.OBJECTIVES: To (a) determine whether a clinical pharmacist's recommendations to physicians regarding optimizing medication therapy are related to medical costs in capitated patients in an internal medicine practice, and (b) compare what primary care physicians (PCPs) in a comparison group actually did proactively to optimize medication therapy versus what a clinical pharmacist would have recommended to them.METHODS: This was a prospective, controlled study comparing 2 internal medicine practices. Study enrollment was performed using a screening process carried out every 1-2 weeks on a rolling basis for 1 year from July 2001 through June 2002. Eligibility criteria for prospective enrollment were (a) 1 or more risk factors: at least 1 chronic disease or an event (e.g., emergency room visit, adverse drug reaction, medication nonadherence) or aged 50 years or older, (b) a scheduled visit to see a PCP within 2 weeks from the screening date or a diagnosis of diabetes without a PCP visit during the first 6 months of the study, (c) need for optimization of medication therapy as determined by a clinical pharmacist on the screening date, and (d) 12 months of continuous insurance eligibility before enrollment in the study. For inclusion in the final study analyses, patients were also required to have continuous insurance eligibility through 12 months from study enrollment. One clinical pharmacist made recommendations to optimize medication therapy in the intervention group. For the comparison group, the same pharmacist proposed recommendations that remained concealed from the physicians. The primary outcome measure was per patient per year (PPPY) medical cost, based on plan liability (gross allow able costs minus patient costs), excluding prescription drug cost. Additional outcome measures included numbers of outpatient visits, hospital admissions, emergency room (ER) visits per 1,000 patients, and hospital days; and percent of recommendations that were accepted by the PCPs. Changes in outcome measures from the pre-intervention to postintervention period were compared across study groups in a difference-indifference analysis, using the Student's t-test for normally distributed data and the Mann-Whitney U-test (nonparametric) for skewed data.RESULTS: There were 127 and 216 adult patients in the intervention and comparison groups, respectively. The primary outcome, change in mean PPPY medical (excluding pharmacy) cost, did not differ significantly between the groups (P = 0.711). The between-group difference in the change in ER visits per 1,000 patients approached statistical significance (P = 0.054). Intervention group patients were more likely than comparison group patients to have the following issues...

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“…We use clinical pharmacists as the agents for changing the design of the caredelivery system, because they perform similar roles at Group Health for other chronic conditions with improved rates of statin and ACE inhibitor use in patients with heart disease and diabetes. Studies show that pharmacy care interventions have positive effects on blood pressure control and medication adherence [79][80][81][82]. Depending on local resources, however, these functions could be delegated to nurses, who might have more comfort with aspects of care unrelated to medications (e.g., lifestyle issues or clinical concerns).…”

Section: Discussionmentioning

confidence: 99%

Electronic Communications and Home Blood Pressure Monitoring (e-BP) study: Design, delivery, and evaluation framework

Green¹,

Ralston²,

Fishman³

et al. 2008

Contemporary Clinical Trials

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Background-Randomized controlled trials have provided unequivocal evidence that treatment of hypertension decreases mortality and major disability from cardiovascular disease; however, blood pressure remains inadequately treated in most affected individuals. This large gap continues despite the facts that more than 90% of adults with hypertension have health insurance, and hypertension is the leading cause of visits to the doctor. New approaches are needed to improve hypertension care. Objectives-The Electronic Communications and Home Blood PressureMonitoring (e-BP) study is a three-arm randomized controlled trial designed to determine whether care based on the Chronic Care Model and delivered over the Internet improves hypertension care. The primary study outcomes are systolic, diastolic, and blood pressure control; secondary outcomes are medication adherence, patient self-efficacy, satisfaction and quality of life, and healthcare utilization and costs.Methods-Hypertensive patients receiving care at Group Health medical centers are eligible if they have uncontrolled blood pressure on two screening visits and access to the Web and an e-mail address. Study participants are randomly assigned to three intervention groups: (a) usual care; (b) home blood pressure monitoring receipt and proficiency training on its use and the Group Health secure patient website (with secure e-mail access to their healthcare provider, access to a shared medical record, prescription refill and other services); or (c) this plus pharmacist care management (collaborative care management between the patient, the pharmacist, and the patient's physician via a secure patient website and the electronic medical record).Conclusion-We will determine whether a new model of patient-centered care that leverages Web communications, self-monitoring, and collaborative care management improves hypertension control. If this model proves successful and cost-effective, similar interventions could be used to improve the care of large numbers of patients with uncontrolled hypertension.

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Physician‐Pharmacist Comanagement of Hypertension: A Randomized, Comparative Trial

Abstract: An evidence-based, systematic approach using physician-pharmacist comanagement for patients with uncontrolled hypertension resulted in improved blood pressure control and reduced average visit costs/patient.

Cited by 172 publications

References 41 publications

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

Take Control of Your Blood pressure (TCYB) study: A multifactorial tailored behavioral and educational intervention for achieving blood pressure control

A Prospective Trial of a Clinical Pharmacy Intervention in a Primary Care Practice in a Capitated Payment System

Electronic Communications and Home Blood Pressure Monitoring (e-BP) study: Design, delivery, and evaluation framework

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