Implementation of a pharmacist-led clinic for hypertensive patients in primary care--a pilot study

Abstract

Objectives: To implement a pharmacist-led Hypertension Management Clinic in one general medical practice. To evaluate the impact of the clinic on blood pressure (BP) control and prevention of coronary heart disease (CHD).

Method: A total of 242 patients attended the pharmacist-led hypertension clinic over a 10-month period. Lifestyle and drug therapy alterations were implemented to achieve British Hypertension Society (BHS) target level BP. A sub-group of 160 patients were used to compare BP control in the clinic setting against that with the general practitioner (GP). Assessment was made of 10-year CHD risk in patients with no artherosclerotic disease. Patients with underlying artherosclerotic disease were prescribed statins, and antiplatelet drugs where indicated.

Main outcome measures: Changes in numbers of hypertensive patients meeting the BHS target level BP. Changes in prescribing of antiplatelet agents and statins for primary and secondary prevention of artherosclerosis.

Results: In 206 patients with established hypertension, the number achieving target level BPs increased from 74 (36%) pre-clinic to 174 (85%) post-clinic; P < 0.001 chi-squared test. After attending the clinic, for 5 months 74 patients (80%) achieved target level BP in the clinic compared with 27 (40%) with standard GP care; P < 0.001 chi-squared test. Of 188 patients assessed for primary prevention therapy, 126 (67%) required treatment with aspirin and 37 (20%) with a statin. Post-clinic 101 (80%) received aspirin compared with 17 (13%) pre-clinic and 34 (92%) received a statin in comparison with 4 (11%) pre-clinic; both P < 0.001 chi-squared test.A total of 52 (96%) of 54 patients received an antiplatelet agent for secondary prevention of artherosclerosis compared with 40 patients (74%) pre-clinic. Thirty six of 54 patients required a statin for secondary prevention. Thirty five patients (97%) received a statin compared with 23 (64%) pre-clinic; both P < 0.01 chi-squared test.

Conclusion: Implementation of a pharmacist-led clinic improved blood pressure control and appropriate prescribing of antiplatelet agents and statins for primary prevention of CHD and secondary prevention of artherosclerosis.