Medical Research: What is the background for this study? What are the main findings?
Response: Numerous studies and meta-analyses have found physician-pharmacist collaborative models can improve blood pressure (BP) control. In these models, pharmacists are located within primary care offices to assist with patient management. The physician delegates responsibility to pharmacists to perform a medication history, identify problems and barriers to achieving disease control, perform counseling on lifestyle modification and adjust medications following hypertension guidelines. However, it was not known if this model would be implemented in a large number of diverse primary care offices, if the effect could be sustained after discontinuation and if the intervention was as effective in under-represented minorities as in Whites. In this study, 32 clinics from throughout the U.S. were randomized to a 9 month intervention that was discontinued, a 24-month pharmacist intervention our usual care. All subjects received structured research measured blood pressure at baseline, 6, 9, 12, 18 and 24 months. We enrolled 625 subjects and 53% were from minority groups, 53% had < 12 years of education, 50% had diabetes or chronic kidney disease and 25% had Medicaid or self-pay for their care payments. All of these variables typically make it much more difficult to achieve BP control. BP control was 43% in the intervention groups and 34% in the control group at 9-months (adjusted OR 1.57 [95% CI 0.99-2.50], p = 0.059). However, when using the higher BP goals in the 2014 guidelines, blood pressure control was achieved in 61% of intervention subjects and 45% of control subjects at 9 months [(adjusted OR, 2.03 [95% CI 1.29-3.22], p=0.003). Of importance was the finding that the degree of systolic BP reduction (6 mm Hg) with the intervention compared to usual care was not only statistically significant but also the same in minority subjects (2/3 Black and 1/3 Hispanic) compared to all subjects. Interestingly, BP control seemed to be maintained in the subjects from minority groups at 18 and 24 months in both the group with the short (9-month) or sustained (24 month) intervention. In contrast, blood pressure control deteriorated slightly in non-minority subjects in all three groups.
Medical Research: What should clinicians and patients take away from your report?
Response: Many primary care offices now employ clinical pharmacists to assist with patient management. This study demonstrates that the physician-pharmacist collaborative model can be implemented in very diverse primary care offices, even when they did not provide these types of services in the past. The study also demonstrates very good BP improvements in Blacks and Hispanics. Clinicians and health systems continue to implement patient-centered strategies and strive for high rates for risk factor control, immunizations and other preventative services. This study provides one model that can be used to improve outcomes and increase the numbers of patients who can achieve these important benchmarks.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: While many studies have utilized this model, we still need research to determine the optimal use of various team members to maximize performance and efficiency. We are currently conducting cost-effectiveness analyses for this study to assist health systems and providers with implementation of this model. We also need additional research to continue to evaluate patient-specific interventions especially for under-represented minorities.
MedicalResearch.com Interview with: Barry L. Carter, PharmD (2015). Physician-Pharmacist Collaboration Improved Blood Pressure Control in Primary Care Offices