Abstract P243: Innovative Care Team Design: An Original Approach To Optimize Patient Outcomes With Our RN-pharmacist Led Hypertension Clinic

Abstract

Background: Bozeman Health (BH) Primary Care provides care to >8000 patients with a diagnosis of hypertension (HTN). In 2019, less than half of these patients had their blood pressure (BP) controlled. The State of Montana Board of Pharmacy grants pharmacists the ability to have collaborative practice agreement(s) with providers. This allows the pharmacist to act as an intermediary to the provider and a ‘safety net’ for the nurses working off protocol. Utilizing evidence-based medication protocols, registered nurses (RNs) with clinical pharmacy collaboration, began treating HTN patients utilizing motivational interviewing, shared decision making, lifestyle modification, risk assessment tools, medication titration and regular follow-up. The program is initiated with a primary care provider (PCP) referral. Methods: The RN-Pharmacist led HTN Clinic was implemented in January 2019 after a 3-month pilot program which showed 90% (35 of 39) of enrolled patients achieved BP goal within 9 weeks or less. Ambulatory care RNs completed a 12-week intensive educational program on HTN. Upon completion of education, RNs managed patient appointments (including telemedicine appointments), charted and worked off medication protocol algorithms. Office notes were sent to the pharmacist to sign prescriptions and subsequently to the PCP for general information. Patients were seen in follow-up every 2-4 weeks with the HTN RN until their BP and personal goals were met. The primary objective of this project was to have 75% of patients referred to the hypertension clinic at goal within 12 weeks. Secondary outcomes included: secondary cause risk assessment, decrease in BMI, and high patient satisfaction scores. Results to date: •Enrolled 607 patients, 74% (237 of 321) at BP goal within 12 weeks •Average decrease in systolic BP - 8.4mmHg and diastolic BP - 5.5mmHg •Net decrease of 0.12kg/m2 in BMI upon graduation •Patient program satisfaction surveys 4.8/5; 5 being “very satisfied” Conclusions: The RN-Pharmacist Led HTN Clinic is an innovative, collaborative, multidisciplinary approach to hypertension management that allows care team members to practice at the top of licensure while improving HTN outcomes and achieving high patient satisfaction.