Evaluation of a pharmaceutical care program for hypertensive patients in rural Portugal

Abstract

Objectives: To evaluate the community pharmacist's capacity to positively influence the results of antihypertensive drug therapy through a pharmaceutical care program and to determine what factors limit the program.

Design: Randomized, controlled study.

Setting: Private pharmacy caring for a semiliterate, rural Portuguese population.

Patients: Random sample of 100 patients with a diagnosis of essential hypertension who had been on drug treatment for less than 6 months. Patients were randomly assigned to an intervention (n = 50) or a control (n = 50) group.

Intervention: Individualized health promotion by a research pharmacist involving monthly appointments for 6 months to monitor blood pressure; assess adherence to treatment; prevent, detect, and resolve drug-related problems (DRPs); and encourage nonpharmacologic measures for blood pressure control. Control patients received traditional care.

Main outcome measures: Control of blood pressure; decreases in systolic/diastolic blood pressure; number of detected, resolved, and prevented DRPs.

Results: From the initial sample of 100 patients, 41 patients in the intervention group and 41 patients in the control group completed the longitudinal study. After 6 months, prevalence of uncontrolled blood pressure decreased by 77.4% in the intervention group (P < .0001) and by 10.3% in the control group (P = .48). Systolic blood pressure fell from a mean +/- standard deviation of 152 mm Hg +/- 23 mm Hg to 129 +/- 15 mm Hg in intervention patients and 148 +/- 16 mm Hg to 143 +/- 20 mm Hg in control patients (P < .001). Twenty-four of 29 (83%) detected actual DRPs were resolved. About 40% of potential DRPs were prevented.

Conclusion: In this rural community, a pharmaceutical care program was associated with significant improvements in blood pressure control in hypertensive patients.