title: Improving hypertension management through pharmacist prescribing; the rural Alberta clinical trial in optimizing hypertension (Rural RxACTION): trial design and methods.
abstract: BACKGROUND
  Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta being the first province in Canada to have independent prescribing by pharmacists, it offers a unique opportunity to evaluate outcomes in patients who are prescribed antihypertensive therapy by pharmacists.
  
  
  METHODS
  The study is a randomized controlled trial of enhanced pharmacist care, with the unit of randomization being the patient. Participants will be randomized to enhanced pharmacist care (patient identification, assessment, education, close follow-up, and prescribing/titration of antihypertensive medications) or usual care. Participants are patients in rural Alberta with undiagnosed/uncontrolled blood pressure, as defined by the Canadian Hypertension Education Program. The primary outcome is the change in systolic blood pressure between baseline and 24 weeks in the enhanced-care versus usual-care arms. There are also three substudies running in conjunction with the project examining different remuneration models, investigating patient knowledge, and assessing health-resource utilization amongst patients in each group.
  
  
  CONCLUSIONS
  To date, one-third of the required sample size has been recruited. There are 15 communities and 17 pharmacists actively screening, recruiting, and following patients. This study will provide high-level evidence regarding pharmacist prescribing.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00878566.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Theresa L
authors.initials: TL
authors.lastname: Charrois
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Dale
authors.initials: D
authors.lastname: Cooney
authors.forename: Richard
authors.initials: R
authors.lastname: Lewanczuk
authors.forename: Michael R
authors.initials: MR
authors.lastname: Kolber
authors.forename: Norman Rc
authors.initials: NR
authors.lastname: Campbell
authors.forename: Meagen
authors.initials: M
authors.lastname: Rosenthal
authors.forename: Sherilyn Kd
authors.initials: SK
authors.lastname: Houle
authors.forename: Ross T
authors.initials: RT
authors.lastname: Tsuyuki
mesh_terms: D000416:Alberta; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D010595:Pharmacists; D011787:Quality of Health Care; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents