Objective:
To compare short and long term blood pressure control with clinical
pharmacy specialist involvement to traditional physician management.
Setting: A non-profit health maintenance organization in the United
States covering approximately 385,000 lives.
Methods: This analysis utilized a prospective parallel design.
Adult patients with a baseline Blood pressure?140/90 mmHg and
receiving at least one antihypertensive medication were eligible
for the study. Eligible hypertension management patients at one
medical office were referred to the office’s clinical pharmacy
specialist (intervention cohort) while at another comparable medical
office they received usual physician-directed care (control cohort).
The primary outcome measure was achievement of a goal BP (<140/90
mmHg) during a six month follow-up. Medical records were also
reviewed approximately 1.5 years post enrollment to assess long-term
BP control after clinical pharmacy-managed patients returned to
usual care. Multivariate analyses were performed to adjust for
baseline cohort differences.
Results: One hundred-thirteen and 111 subjects in the intervention
and control cohorts completed the study, respectively. At the
end of the follow-up period, clinical pharmacy-managed subjects
were more likely to have achieved goal BP (64.6%) and received
a thiazide diuretic (68.1%) compared to control subjects (40.7%
and 33.3%, respectively) (adjusted p=0.002 and p<0.001, respectively).
The proportion of clinical pharmacy-managed subjects with controlled
BP decreased to 22.2% after returning to usual care (p<0.001).
Conclusion: Clinical pharmacy involvement in hypertension management
resulted in increased BP control. Loss of long-term control after
discontinuation of clinical pharmacy management supports a change
in care processes that prevent patients from being lost to follow-up.
