Project ImPACT: Hypertension Outcomes of a Pharmacist-Provided Hypertension Service

Objective: To evaluate the impact of pharmacists, working collaboratively with patients, on blood pressure control, lifestyle goal setting, adherence to antihypertensive therapy, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Methods: Self-declared hypertensive patients met with the pharmacist for blood pressure monitoring, lifestyle goal setting, and education about medications and disease state on four occasions over a 6–month period. Practice innovation: A community pharmacy partnered with an employer wellness plan to provide education and monitoring for patients with hypertension based on home blood pressure readings obtained using monitors that wirelessly transmit information to the pharmacist. Main outcome measure(s): Percentage of patients at blood pressure goal, mean blood pressure, percentage of patients with lifestyle goals, medication adherence, patient knowledge and satisfaction, and modification of cardiovascular risk factors. Results: Patients not at their goal blood pressure at baseline had a significant decrease in blood pressure and a significant increase in achievement of their blood pressure goals. Across the population, no significant changes were seen in the primary outcome, lifestyle goals, medication adherence or modification of cardiovascular risk factors. Patient knowledge increased from baseline and satisfaction with the service was high. Conclusion: Blood pressure control improved in patients not at their treatment goal. All patients increased their knowledge about hypertension and reported high satisfaction with the pharmacy service. Pharmacy services should be offered to patients who are more likely to reap a benefit. Home blood pressure readings are useful to inform clinical decision making and supplement patient consultation within the pharmacy setting. Relevance and Contribution to Literature Over 74 million Americans have elevated blood pressure that warrants treatment. 1 Uncontrolled hypertension leads to end stage renal disease, heart failure, myocardial infarction, stroke, and is the number one attributable risk factor for death throughout the world. 2 Despite understanding the risks associated with hypertension, approximately 30 percent of adults are still unaware that they have hypertension, greater than 40 percent of individuals with hypertension are not being treated, and two-thirds of hypertensive patients on Corresponding author: Lynette R. Moser, PharmD Department of Pharmacy Practice, Wayne State University 259 Mack Ave, Suite 2190, Detroit, MI 48201 [email protected], fax#: 313-577-5369 medical therapy are not being controlled to their optimal blood pressure goals. 3 Non-adherence to lifestyle changes and medications has been identified as a barrier to optimal antihypertensive therapy. 4 Patient education, simplifying regimens, and behavioral strategies to remind patients to take their medications have all been shown to improve adherence to medications and blood pressure control. 5 Pharmacists are in a unique position to provide education to patients with hypertension and to implement other strategies to improve adherence to lifestyle changes and medication regimens. Project ImPACT: Hypertension introduces a new element into pharmacistprovided care by equipping patients with unique home blood pressure monitoring devices that can wirelessly transmit readings to the pharmacy computer. This information is used Original Research PRACTICE-BASED RESEARCH http://z.umn.edu/INNOVATIONS 2013, Vol. 4, No. 3, Article 126 INNOVATIONS in pharmacy 2 by the pharmacist when assembling a complete picture of that patient’s blood pressure control during face-to-face visits. Incorporating home blood pressure monitoring data provides the pharmacist with the unique teaching opportunity of relating treatment and monitoring with patient goal setting. Objective Project ImPACT: Hypertension created a value-based hypertension benefit, by partnering with an employer that includes appropriate financial incentives to employees to encourage their participation in the program, which includes education, monitoring, and counseling. This project utilized a model of patient-focused pharmacy care that incorporated structured visits, financial incentives, enhanced selfmonitoring, and disease state, lifestyle, and medication education. The objectives of Project ImPACT: Hypertension were to: Assist identified patients with hypertension in achieving national treatment goals; Increase nutritional, exercise, and weight loss goal setting among patients with hypertension; Improve participant adherence to medication therapy; Improve patient knowledge and health satisfaction; and, Modify cardiovascular risk factors.