Implementation modifications and outcomes of a pharmacist-led primary care remote hypertension service

National guidelines recommend team-based remote blood pressure (BP) management as standard care, but implementation in actual clinical settings is complex and requires more insights from real-world practices.

We offer practical insights and share lessons learned regarding challenges and potential solutions for advancing pharmacist-led remote physiologic monitoring (RPM) for hypertension. We aim to: (1) detail key contextual factors that informed and shaped the intervention; (2) describe intervention components, noting when and why specific modifications were introduced; and (3) analyze how implementation decisions impacted outcomes over time.

Guided by the Exploration, Preparation, Implementation, and Sustainment framework, we describe the key practice contextual factors that contributed to implementation of RPM for hypertension.

Applying the Framework for Reporting Adaptations and Modifications to Evidence-based Interventions, we identify when and why modifications were made. We detail intervention components and various strategies used for dissemination, implementation processes, innovation integration, capacity-building, and scale-up.

We use descriptive statistics to report measures of reach, effectiveness, adoption, and implementation outcomes over time. Additionally, for reach and effectiveness, we use unadjusted chi-squared analyses to compare trends in proportions across early, mid, and late implementation periods.

Over time, there was a trend toward increasing provider referrals (73 by year 3), new patient enrollments (362 in year 3), and RPM codes billed (1579 by year 3). Payor mix, a measure of program reach, saw a statistically significant improvement over time (P < 0.01), while the proportion of patients achieving target BP improved but was not statistically significant (P = 0.53).

Multilevel alignment and continuous adaptation efforts contributed to successful implementation of a pharmacist-led RPM intervention for hypertension with improvement in reach over time. We share our insights as a resource for primary care practitioners, organizations, and policy makers seeking to implement RPM for hypertension.