Abstract

 
 
 
 Purpose: To assess the adherence of cardiologists to JNC7 and the impact of pharmacists in reducing clinical inertia by managing high blood pressure in the cardiology out-patient department of the Armed Forces Institute of Cardiology, Rawalpindi, Pakistan.
 Methods: This was a pre- and post-interventional prospective study in which data was abstracted from patients’ history notes or prescription of selected patients at baseline and follow-up visits by applying a reliable tool. The data were abstracted again from the same patients to evaluate the cardiologists’ adherence with the same parameters after 2,4 and 6 months. The sample size for this study was 116 patients and descriptive statistics were used for categorical variables. For the comparison of cardiologist’s adherence to JNC7, means and paired ‘t’ test were used at the level of 0.05 significance.
 Results: At baseline, the mean overall percentage of cardiologists’ adherence to JNC7 was 46.7 ± 18.9 %. This significantly improved to 98.8 ± 6.0 % after 2 months of the pharmacist intervening by way of discussions with cardiologists. The cardiologists’ adherence was further improved to 100 % after 4 and 6 months.
 Conclusion: Improvement in cardiologists’ adherence to JNC 7 guidelines and involvement of the pharmacist enhance the documentation of BP goal, lifestyle modifications and uncontrolled BP. All these helps to overcome clinical inertia that ultimately leads to better BP control and rational use of medicines.
 
 
 
Highlights
Despite the availability of effective drugs and practice guidelines, the control of hypertension is far from ideal all over the world
Almost 18 % of the total general population of Pakistan is suffering from high blood pressure and every one out of three Pakistani which is above the age of
Pharmacists are considered as health care team members, physicians are reluctant to accept their role in the health care system in Pakistan because they have poor faith and trust in the pharmacist’s capabilities, concerning inpatient care due to a lack of interaction between physicians and pharmacists
Summary
Despite the availability of effective drugs and practice guidelines, the control of hypertension is far from ideal all over the world. Physician-related factors are; clinician inertia (failure to intensify therapy when required), poor physician-patient relationship, lack of guidelines and disagreement with the guidelines. In the health care system of Pakistan, the role of the pharmacist and pharmaceutical care is not well defined and pharmacists are not providing direct patient care [2,3]. The reasons are; shortage of qualified pharmacists, lack of standard practice guidelines, insufficient training in pharmaceutical care practice and poor relationship between pharmacists and physicians. Pharmacists are considered as health care team members, physicians are reluctant to accept their role in the health care system in Pakistan because they have poor faith and trust in the pharmacist’s capabilities, concerning inpatient care due to a lack of interaction between physicians and pharmacists
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