Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans.

Abstract

Clinical pharmacists are utilized in Veterans Health Administration (VHA) facilities to assist with management of patients with chronic conditions including hypertension. The goal of this study was to examine blood pressure (BP) control after discontinuation of an intensive pharmacist-managed intervention. The study was conducted at a single Midwest VHA medical center and two affiliated community-based outpatient clinics. Patients with uncontrolled BP received an intensive pharmacist intervention for the first 6months. Patients were then stratified based on whether their BP was controlled or not and were randomized to either continue the intervention for another 24months (30month total time period) or the intervention was discontinued following one-time receipt of educational materials. Mean systolic and diastolic BPs were reduced (P<.001) in diabetic patients (8.0±14.4mm Hg and 4.0±9.1mm Hg, respectively) and in nondiabetic patients (14.0±16.4mm Hg and 5.0±10.0mm Hg, respectively) following the 6-month intervention, with 54% of the total sample achieving BP control. BP control and the reduction in mean BP was maintained to a similar degree in both study groups at 12, 18, 24, and 30months. There were no significant differences in BP at any of the follow-up periods in patients who did and did not receive the continued pharmacist intervention. This study found that BP control was maintained for at least 24months following discontinuation of an intensive pharmacist intervention. These findings were seen in both the group that had a continued pharmacist intervention and in the group that had a one-time educational session when the intervention was discontinued. This study suggests that once BP control is achieved following a pharmacist intervention, patients can be referred back to their primary care provider for continued follow-up.