Abstract
BackgroundNon-adherence to medicines by patients and suboptimal prescribing by clinicians underpin poor blood pressure (BP) control in hypertension. In this study, a training program was designed to enable community pharmacists to deliver a service in hypertension management targeting therapeutic adjustments and medication adherence. A comprehensive evaluation of the training program was undertaken.MethodsTailored training comprising a self-directed pre-work manual, practical workshop (using real patients), and practice scenarios, was developed and delivered by an inter-professional team (pharmacists, GPs). Supported by practical and written assessment, the training focused on the principles of BP management, BP measurement skills, and adherence strategies. Pharmacists’ experience of the training (expectations, content, format, relevance) was evaluated quantitatively and qualitatively. Immediate feedback was obtained via a questionnaire comprising Likert scales (1 = “very well” to 7 = “poor”) and open-ended questions. Further in-depth qualitative evaluation was undertaken via semi-structured interviews several months post-training (and post service implementation).ResultsSeventeen pharmacists were recruited, trained and assessed as competent. All were highly satisfied with the training; other than the ‘amount of information provided’ (median score = 5, “just right”), all aspects of training attained the most positive score of ‘1’. Pharmacists most valued the integrated team-based approach, GP involvement, and inclusion of real patients, as well as the pre-reading manual, BP measurement workshop, and case studies (simulation). Post-implementation the interviews highlighted that comprehensive training increased pharmacists’ confidence in providing the service, however, training of other pharmacy staff and patient recruitment strategies were highlighted as a need in future.ConclusionsStructured, multi-modal training involving simulated and inter-professional learning is effective in preparing selected community pharmacists for the implementation of new services in the context of hypertension management. This training could be further enhanced to prepare pharmacists for the challenges encountered in implementing and evaluating services in practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0434-y) contains supplementary material, which is available to authorized users.
Highlights
Brief lecture15 min Principles of blood pressure (BP) measurementBrief lecture, practical workshop 30 min Practical BP measurementPractice workshop; competency 90 min assessmentHypertension management Lecture45 min Medication adherence assessment and intervention, inter-professional collaboration) 30 minCase scenarios (four hypothetical practice cases which involved identifying individual patient treatment needs, optimal therapy and potential solutions, assessment of complex patients, supporting patients with multiple co-morbidities)Workshop, group discussionCase assessment
A training program was developed for community pharmacists who were recruited to participate in an intervention trial evaluating the impact of a targeted pharmacist-led service in hypertension management (Fig. 1; Fig. 2)
Pharmacists were recruited from within each of the two Sydney metropolitan regions where the service was to be piloted in an intervention trial (Northern Sydney and Sutherland Medicare Locals, NSW, Australia), and were selected if they had participated in previous pharmacy intervention studies [16] and whose premises met the following inclusion criteria:
Summary
Non-adherence to medicines by patients and suboptimal prescribing by clinicians underpin poor blood pressure (BP) control in hypertension. Hypertension responds well to drug therapy, only 40–60 % of diagnosed hypertensive patients in Australia have their blood pressure (BP) well controlled [3, 4]. This is due to a combination of suboptimal adherence to medications on the part of patients and therapeutic inertia (suboptimal adherence to guidelines) on the part of prescribers [5,6,7]. Compared to non-adherent patients, those who are adherent are significantly less likely to develop a cardiovascular event [9]
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