title: Implementation of adherence support for patients with hypertension despite antihypertensive therapy in general practice: a cluster randomized trial.
abstract: BACKGROUND
  Uncontrolled hypertension despite treatment is highly prevalent among hypertension patients. Electronic monitoring of medication adherence has been proven to be effective in improving blood pressure. The aim of the study was to compare the effectiveness of intensive support for implementation of this tool in community pharmacies with minimal implementation support.
  
  
  METHODS
  In a cluster randomized trial, 25 control pharmacies received a manual and 32 experimental pharmacies received intensive support to enhance implementation of electronic monitoring.
  
  
  METHODS
  the number of patients included for electronic monitoring. Secondary outcomes included mean change in systolic blood pressure (SBP) and percentage of patients with adequate SBP control.
  
  
  RESULTS
  The experimental group yielded consistently higher scores on all the steps of the implementation process than the control group, but none of these differences were significant. The mean number of patients per pharmacy included for electronic monitoring in a 3-9-months period was 1.6 in the experimental group vs. 1.0 in the control group (difference = 0.7, 95% confidence interval = -0.4; 1.7). The following patient outcomes were pooled because there were no differences between the experimental and the control group. Mean change of SBP/diastolic blood pressure (DBP) was -12 and -6 mm Hg, respectively, SBP dropped <140 mm Hg in 20.9% of all patients. In 13.6% of all patients control of SBP was achieved without treatment intensification.
  
  
  CONCLUSIONS
  The intensive implementation program enhanced pharmacist performance, but appeared insufficient to overcome all problems with the implementation of electronic monitoring. The major restrictive factors concerned general practitioner (GP) involvement and the identification of eligible patients.
authors.affiliation: IQ Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. c.vandesteeg-vangompel@iq.umcn.nl
authors.forename: Caroline H P A
authors.initials: CH
authors.lastname: van de Steeg-van Gompel
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: De Smet
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009426:Netherlands; D010594:Pharmacies; D010595:Pharmacists; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics