Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

Pharmacy Practice

  • Beata V. Bajorek1Graduate School of Health – Pharmacy, University of Technology Sydney. Broadway, NSW, Australia.
  • Kate S. LeMay2Woolcock Institute of Medical Research, University of Sydney. Glebe, NSW, Australia.
  • Parker J. Magin3Discipline of General Practice, University of Newcastle. Callaghan, NSW, Australia.
  • Christopher Roberts4Sydney Medical School – Northern, Hornsby Ku-ring-Gai Hospital. Hornsby, NSW, Australia.
  • Ines Krass5Faculty of Pharmacy, University of Sydney. Sydney, NSW, Australia.
  • Carol L. Armour6Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Woolcock Institute of Medical Research, University of Sydney. Glebe, NSW, Australia.

Volume 14 Issue 2 Pages 1-13

DOI: 10.18549/PharmPract.2016.02.723

Abstract

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control – usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service. Results: Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening. Conclusion: A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a stepwise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.

Keywords

  • Hypertension
  • Community Pharmacy Services
  • Interprofessional Relations
  • Medication Adherence
  • Medication Therapy Management
  • Methodology
  • Australia
Pharmacy Practice

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