A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control.
This was a prospective, cluster randomized controlled trial in patients with uncontrolled hypertension aged 21 to 85 years (mean, 61 years). Pharmacists made recommendations to physicians for patients in the intervention clinics (n=101) but not patients in the control clinics (n=78). The mean adjusted difference in systolic blood pressure (BP) between the control and intervention groups was 8.7 mm Hg (95% confidence interval [CI], 4.4-12.9), while the difference in diastolic BP was 5.4 mm Hg (CI, 2.8-8.0) at 9 months. The 24-hour BP levels showed similar effects, with a mean systolic BP level that was 8.8 mm Hg lower (CI, 5.0-12.6) and a mean diastolic BP level that was 4.6 mm Hg (CI, 2.4-6.8) lower in the intervention group. BP was controlled in 89.1% of patients in the intervention group and 52.9% in the control group (adjusted odds ratio, 8.9; CI, 3.8-20.7; P<.001). Physician/pharmacist collaboration achieved significantly better mean BP values and overall BP control rates, primarily by intensification of medication therapy and improving patient adherence.
Carter
Barry L
BL
Division of Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA. barry.carter@uiowa.edu
Bergus
George R
GR
Dawson
Jeffrey D
JD
Farris
Karen B
KB
Doucette
William R
WR
Chrischilles
Elizabeth A
EA
Hartz
Arthur J
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016000:Cluster Analysis; D003299:Cooperative Behavior; D004521:Educational Measurement; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010595:Pharmacists; D010820:Physicians; D011446:Prospective Studies; D013599:Systole