Impact of collaborative and multidisciplinary care on management of hypertension in chronic kidney disease outpatients

Abstract

Objective In patients with chronic kidney disease (CKD), blood-pressure (BP) control is crucial. ProFiL, a training and communication-network programme, is designed to optimize community pharmacists' management of drug-related problems among CKD outpatients. This study evaluates the impact of ProFiL on BP control and management of hypertension treatment. Methods In a 6-month cluster randomized trial, community pharmacies of CKD outpatients (creatinine clearance, <60 ml/min) attending a predialysis clinic in Quebec, Canada, were randomly assigned to ProFiL (intervention) or usual care (UC). ProFiL community pharmacists attended a training workshop, received patient information and had access to a hospital-pharmacist consultation service. UC pharmacists provided routine care. Key findings Eighty-nine patients (ProFiL, 48; UC, 41) participated. At 6 months, adjusted mean systolic/diastolic BP changes, taking within-cluster correlation into account, were −6.9/−0.4 mmHg in ProFiL patients compared with +4.7/+2.2 mmHg in UC (between-groups differences, P value = 0.021/0.348). Some 41 hypertension drug-related problems were identified. Community pharmacists wrote 25 recommendations (ProFiL, 24; UC, 1; P value = 0.007), 12 of which, all by ProFiL pharmacists, dealt with hypertension (P value = 0.009 compared with UC). Patients with written hypertension recommendations had a greater decrease in mean systolic BP (−11.6 mmHg; P value = 0.035), and BP was controlled in a higher proportion of them (relative risk, 2.14; P value = 0.011). Conclusion ProFiL, a collaborative and multidisciplinary care programme, may help pharmacists to intervene more often to detect and manage hypertension drug-related problems and optimize BP control in CKD outpatients.