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. 2016 Apr-Jun;14(2):723.
doi: 10.18549/PharmPract.2016.02.723. Epub 2016 Jun 15.

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

Beata Bajorek  1 , Kate S Lemay  2 , Parker Magin  3 , Christopher Roberts  4 , Ines Krass  5 , Carol L Armour  6
Affiliations

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

Beata Bajorek et al. Pharm Pract (Granada). 2016 Apr-Jun.

Abstract

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension.

Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges.

Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service.

Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening.

Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

Keywords: Australia; Community Pharmacy Services; Hypertension; Interprofessional Relations; Medication Adherence; Medication Therapy Management; Methodology.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Study design BP = blood pressure; QoL = Quality of Life; MMAS = Morisky Medication Adherence Scale; GP = General Practitioner. Use of the ©MMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA.
Figure 2
Figure 2
Flowchart of adherence program based on the Health Collaboration Model (HCM) (undertaken for 14 patients)
See this image and copyright information in PMC

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