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HEALTH CARE REFORM
Physician and Pharmacist Collaboration to Improve Blood Pressure Control
Barry L. Carter, PharmD;
Gail Ardery, PhD;
Jeffrey D. Dawson, ScD;
Paul A. James, MD;
George R. Bergus, MD;
William R. Doucette, PhD;
Elizabeth A. Chrischilles, PhD;
Carrie L. Franciscus, MA;
Yinghui Xu, MS
Arch Intern Med. 2009;169(21):1996-2002.
Background Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The objective of this study was to evaluate if a physician and pharmacist collaborative model in community-based medical offices could improve BP control.
Methods This was a prospective, cluster randomized, controlled clinical trial with clinics randomized to a control group (n = 3) or to an intervention group (n = 3). The study enrolled 402 patients (mean age, 58.3 years) with uncontrolled hypertension. Clinical pharmacists made drug therapy recommendations to physicians based on national guidelines. Research nurses performed BP measurements and 24-hour BP monitoring.
Results The mean (SD) guideline adherence scores increased from 49.4 (19.3) at baseline to 53.4 (18.1) at 6 months (8.1% increase) in the control group and from 40.4 (22.6) at baseline to 62.8 (13.5) at 6 months (55.4% increase) in the intervention group (P = .09 for adjusted between-group comparison). The mean BP decreased 6.8/4.5 mm Hg in the control group and 20.7/9.7 mm Hg in the intervention group (P < .05 for between-group systolic BP comparison). The adjusted difference in systolic BP was –12.0 (95% confidence interval [CI], –24.0 to 0.0) mm Hg, while the adjusted difference in diastolic BP was –1.8 (95% CI, –11.9 to 8.3) mm Hg. The 24-hour BP levels showed similar effect sizes. Blood pressure was controlled in 29.9% of patients in the control group and in 63.9% of patients in the intervention group (adjusted odds ratio, 3.2; 95% CI, 2.0-5.1; P < .001).
Conclusions A physician and pharmacist collaborative intervention achieved significantly better mean BP and overall BP control rates compared with a control group. Additional research should be conducted to evaluate efficient strategies to implement team-based chronic disease management.
Trial Registration clinicaltrials.gov Identifier: NCT00201019
Author Affiliations: Department of Pharmacy Practice and Science, College of Pharmacy (Drs Carter, Ardery, and Doucette), Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (Drs Carter, James, and Bergus and Ms Xu), and Departments of Biostatistics (Dr Dawson) and Epidemiology (Dr Chrischilles), College of Public Health, University of Iowa, and Center for Research in Implementation in Innovative Strategies in Practice, Iowa City Veterans Administration (Dr Carter and Ms Franciscus), Iowa City.
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