The pharmaceutical care of patients with hypertension: an examination of service models in primary care in the US.

Abstract

In the UK, the delivery of health care in cardiovascular disease is guided by national service frameworks', which are a source of standards of practice and evidence that help to define and aid the implementation of service models capable of responding to public health goals. The revised British Hypertension Society guidelines reflect a lower target blood pressure consistent with those recommended in the US and by the WHO. The lowering of the target for the control of blood pressure has increased the estimated proportion of treated patients with inadequate control in the UK from 37% to 72%. To identify the requirements for the provision of a pharmacy service that supports hypertension monitoring, and to gain insights into how such a service might be delivered as part of a wider provision of pharmaceutical care in the UK. Two pharmacists followed a structured programme of observation involving three centres in the United States (Minnesota, Colorado and Iowa). Twelve clinical settings were observed, and the pharmacists who provided the services were also the subjects of documented interviews. The settings offered different models of pharmaceutical care from which issues relevant to the international development of such services were identified. Differences noted between the service models observed included; physical environment of the community pharmacy, the use and type of documentation, methods of blood pressure measurement, extent of monitoring and follow-up, inter-professional communication and service orientation in terms of the provision of comprehensive pharmaceutical care to patients or specific disease management. If clearly defined operational models of pharmaceutical care practice in the primary care setting are to form part of a national public health strategy in the UK, they must also be capable of responding to local opportunities and patients' needs. Future development of models and services must be patient-centred and more widely informed by the range of practice experience gained elsewhere.