A single, global intervention for medication-related problems does not improve blood pressure control

Abstract

The purpose of this study was to determine if a single intervention by a clinical pharmacist/geriatrician physician team for patients at high risk for medication-related problems could improve patient outcomes. Patients ≥ 65 years of age and prescribed > 5 scheduled medications in a VA primary care clinic were enrolled. Randomized subjects received usual care (control) or usual care plus an evaluation by a clinical pharmacist/geriatrician team. When drug therapy problems were identified, the clinical pharmacist and geriatrician physician developed specific recommendations for the patient's primary care provider. This report describes the impact on a study subpopulation with hypertension who had blood pressures (BP) recorded during the six- month period before (pre), and the six-month period (post) after, the intervention. There were 101 control and 79 intervention patients with a mean age of 74 years; 98% were white. In spite of lack of BP control at the enrollment date, 36 control (35%) and 36 (46%) intervention did not have a follow-up blood pressure within six months of the enrollment date. For those who had both a pre and enrollment BP, there was a significant increase in systolic BP from pre-enrollment to enrollment in the intervention group and a trend for an increase in the control group (Table). For those who had both an enrollment and a post- BP, there was a significant reduction in BP in both the control and intervention groups following enrollment with no difference between groups. 1−P = 0.06. 2−p = 0.045. 3−p < 0.001; all compared to enrollment values. 1−P = 0.06. 2−p = 0.045. 3−p < 0.001; all compared to enrollment values. Our data demonstrate that in spite of a single intervention designed to resolve global medication-problems, including poor BP control, BP did not improve to a greater extent in the intervention group compared to the control group. The reason why BP declined in both groups is not entirely clear. A high percentage of patients in both groups who did not have controlled BP at enrollment did not have BP follow-up within 6 months. These results suggest that a single intervention designed to improve overall drug therapy had no effect on BP control or follow-up.