[Improving blood pressure control with physician/pharmacist collaboration]

Studies have shown that it is very important to control blood pressure in patients with diabetes. Unfortunately, blood pressure control throughout the world is poor. Numerous studies have used interdisciplinary team-based care to improve the control of many chronic conditions including hypertension and diabetes. This discussion will focus on the results of a study we recently conducted involving clinical pharmacists located in physician offices. The study was a randomized, cluster trial in five clinics. The pharmacists assessed patients with poorly controlled blood pressure and made recommendations to the physicians to change therapy. The patients in control sites received usual care. Blood pressure was controlled in 89% of patients in the intervention group compared to 53% in the control group (p < 0.001). Blood pressure was controlled in 82% of patients with diabetes in the intervention group compared to 24% in the control group (p = 0.002). This was the first study of team-based care that used ambulatory BP monitoring. Ambulatory blood pressure was reduced significantly more in the intervention group compared to the control group. The primary reason for the superior results in the intervention group was more intensive use of medications to control blood pressure. This study demonstrates that blood pressure can be controlled in a high number of patients with diabetes following our physician/pharmacist collaborative model.