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Pharmacist Hypertension Management Quality Review at an Ambulatory Care Clinic
Kayla Chonko1, Sandra Axtell2, Bianca Mayzel2
1Clinical Pharmacy Resident, Department of Pharmacy, Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA.
Insights
Pharmacist-led hypertension management significantly lowered systolic blood pressure (SBP) by over 10 mm Hg. This approach improved patient blood pressure control compared to traditional physician/nurse management.
Area of Science:
- Cardiology
- Pharmacology
- Ambulatory Care
Background:
- A 10 mm Hg reduction in systolic blood pressure (SBP) is linked to decreased cardiovascular disease risk.
- Pharmacist involvement in blood pressure management may facilitate this reduction.
Purpose of the Study:
- To evaluate the effectiveness of pharmacist-led hypertension management within a collaborative practice agreement.
- To compare pharmacist management against traditional physician/nurse care in an ambulatory setting.
Main Methods:
- A two-phase study involving retrospective chart review and prospective pharmacist-managed visits.
- Primary outcome: change in SBP; Secondary outcomes: blood pressure goal achievement and medication adherence.
Main Results:
- Prospective pharmacist management resulted in an average SBP reduction of 10.83 mm Hg (P = .0035).
- Significantly more patients achieved the <130/80 mm Hg goal under pharmacist care (56.5%) versus physician/nurse care (20.8%, P = .012).
Conclusions:
- Pharmacist management of hypertension can achieve clinically significant SBP reduction exceeding 10 mm Hg.
- This collaborative model increases the proportion of patients reaching their blood pressure targets.
Abstract:
Background: A reduction of 10 mm Hg in systolic blood pressure (SBP) significantly decreases the risk of major cardiovascular disease events. Pharmacists' management of blood pressure may assist with this reduction. Objective: Assess the impact of pharmacist management of hypertension via a collaborative practice agreement with physicians in an ambulatory care clinic. Methods: The first phase of this study was a retrospective chart review of physician/nurse hypertension visits from October 2019 to August 2020. The second prospective phase consisted of pharmacist managed hypertension visits from December 2020 to January 2021. The primary outcome was the change in SBP from the beginning to the end of the study period in the prospective group. Secondary outcomes included the proportion of patients achieving their blood pressure goal and the proportion of patients adherent to all antihypertensive medications at their follow-up visits in both groups. This study was institutional review board approved. Results: Forty-seven patients were included and analyzed (24 in the retrospective group and 23 in the prospective group). Patients in the prospective group had an average SBP lowering of 10.83 mm Hg (P = .0035). Thirteen patients (56.5%) met their blood pressure goal of <130/80 mm Hg in the prospective group, compared to 5 patients (20.8%) in the retrospective group (P = .012). One adverse event occurred during this study. Limitations included small sample size and short duration of study. Conclusion: Patients had an average SBP lowering of >10 mm Hg. More patients reached a goal blood pressure of <130/80 mm Hg when managed by pharmacists.
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