Implementation of a hypertension clinic using a streamlined treatment algorithm

Area of Science:

• Clinical Pharmacy
• Cardiovascular Medicine
• Public Health

Background:

• Emergency department (ED) patients with elevated blood pressures (BPs) often experience gaps in follow-up care.
• A large public hospital's ED identified a need for improved continuity of care for these patients.

Purpose of the Study:

• To describe the implementation of a pharmacist-managed clinic using the Simplified Treatment Intervention to Control Hypertension (STITCH) algorithm.
• To assess physician acceptance and identify implementation challenges.
• To create a bridge from ED care to primary care for patients with hypertension.

Main Methods:

• A modified STITCH algorithm was applied to manage patients pending their first primary care appointment.
• The clinic coordinated initial pharmacotherapy, monitored patients, assessed for complications, and provided patient education.
• Physician support was gained through targeted education to address concerns about initiating ED-based hypertension therapy.

Main Results:

• Early experience showed increased physician willingness to initiate hypertension treatment in the ED.
• The clinic provided appropriate follow-up services within a shorter timeframe (approximately two weeks).
• The intervention facilitated adequate BP control in a transient, low-income patient population.

Conclusions:

• A hypertension-focused clinic utilizing a streamlined algorithm can effectively bridge urgent care to primary care.
• This model facilitates blood pressure control in vulnerable patient populations.
• Pharmacist-managed clinics can improve hypertension management continuity.