Effectiveness of a Hypertension Care Management Program Provided by Clinical Pharmacists for Veterans

Abstract

To evaluate the effectiveness of a hypertension care management program provided by clinical pharmacists. Pre- and postintervention design with retrospective medical record review. Tertiary care Veterans Affairs medical center and affiliated primary care clinics. Five hundred seventy-three veterans with hypertension who were referred to the program between June 1, 2007, and May 31, 2008. Participation in the hypertension care management program provided by clinical pharmacists who met individually with patients, orchestrated drug therapy, and provided patient counseling. The following data were collected from patients' medical records: demographics, date of program referral, dates of pharmacist visits, blood pressure at each visit, concurrent antihypertensive drugs and their dosages, drug changes at each visit, as well as patient education topics discussed during a visit. To ensure a minimum of 6 months of follow-up data for all patients, data collection continued through November 30, 2008, for a total study duration of 18 months. The primary study outcome was the difference between systolic and diastolic blood pressure measurements at the final pharmacist care management visit and those measurements at the initial pharmacist visit. Systolic blood pressure decreased from a mean ± SD of 141.3 ± 18.5 mm Hg at the initial pharmacist visit to 130.1 ± 13.8 mm Hg at the final pharmacist visit, and diastolic blood pressure decreased from 79.1 ± 12.2 to 74.5 ± 10.3 mm Hg (p<0.001 for both comparisons). The secondary outcome was the proportion of patients reaching blood pressure treatment goals at the final visit compared with the initial pharmacist visit. Of the 573 patients, 431 (75.2%) reached blood pressure treatment goals at the final visit (p ≤ 0.001) compared with 221 (38.6%) at the initial visit. The study patients had several comorbid diseases, including diabetes mellitus (196 patients [34.2%]) and chronic kidney disease (43 patients [7.5%]). Both study outcomes were also assessed for these subgroups. Patients referred to the hypertension care management program had a significant reduction in blood pressure, and most met their blood pressure treatment goals. This pharmacist-managed program may be an efficient method of care delivery to improve patient outcomes.