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A Randomized Trial of the Effect of Community Pharmacist and Nurse Care on Improving Blood Pressure Management in Patients With Diabetes MellitusStudy of Cardiovascular Risk Intervention by Pharmacists–Hypertension (SCRIP-HTN)
Donna L. McLean, MN, RN NP;
Finlay A. McAlister, MD, MSc, FRCPC;
Jeffery A. Johnson, BSP, PhD;
Kathryn M. King, RN, PhD;
Mark J. Makowsky, BSP, PharmD;
Charlotte A. Jones, PhD, MD, FRCPC;
Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC; for the SCRIP-HTN Investigators
Arch Intern Med. 2008;168(21):2355-2361.
Background Blood pressure (BP) control in patients with diabetes mellitus is difficult to achieve and current patterns are suboptimal. Given increasing problems with access to primary care physicians, community pharmacists and nurses are well positioned to identify and observe these patients. This study aimed to determine the efficacy of a community-based multidisciplinary intervention on BP control in patients with diabetes mellitus.
Methods We performed a randomized controlled trial in 14 community pharmacies in Edmonton, Alberta, Canada, of patients with diabetes who had BPs higher than 130/80 mm Hg on 2 consecutive visits 2 weeks apart. Care from a pharmacist and nurse team included a wallet card with recorded BP measures, cardiovascular risk reduction education and counseling, a hypertension education pamphlet, referral to the patient's primary care physician for further assessment or management, a 1-page local opinion leader–endorsed evidence summary sent to the physician reinforcing the guideline recommendations for the treatment of hypertension and diabetes, and 4 follow-up visits throughout 6 months. Control-arm patients received a BP wallet card, a pamphlet on diabetes, general diabetes advice, and usual care by their physician. The primary outcome measure was the difference in change in systolic BP between the 2 groups at 6 months.
Results A total of 227 eligible patients were randomized to intervention and control arms between May 5, 2005, and September 1, 2006. The mean (SD) patient age was 64.9 (12.1) years, 59.9% were male, and the mean (SD) baseline systolic/diastolic BP was 141.2 (13.9)/77.3 (8.9) mm Hg at baseline. The intervention group had an adjusted mean (SE) greater reduction in systolic BP at 6 months of 5.6 (2.1) mm Hg compared with controls (P = .008). In the subgroup of patients with a systolic BP greater than 160 mm Hg at baseline, BP was reduced by an adjusted mean (SE) of 24.1 (1.9) mm Hg more in intervention patients than in controls (P < .001).
Conclusion Even in patients who have diabetes and hypertension that are relatively well controlled, a pharmacist and nurse team–based intervention resulted in a clinically important improvement in BP.
Trial Registration clinicaltrials.gov Identifier: NCT00374270
Author Affiliations: Department of Medicine, Faculty of Medicine (Ms McLean and Drs McAlister and Tsuyuki), School of Public Health (Drs McAlister, Johnson, and Tsuyuki), and Faculty of Pharmacy and Pharmaceutical Sciences (Drs Makowsky and Tsuyuki), University of Alberta, Edmonton; and Institute of Health Economics (Drs McAlister, Johnson, and Tsuyuki) and Departments of Community Health Sciences (Drs King and Jones) and Medicine (Dr Jones), Faculty of Medicine, and Faculty of Nursing (Dr King), University of Calgary, Calgary, Alberta, Canada.
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