title: Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial.
abstract: BACKGROUND
  Even in high-performing health systems, some patients with diabetes mellitus have poor blood pressure (BP) control because of poor medication adherence and lack of medication intensification. We examined whether the Adherence and Intensification of Medications intervention, a pharmacist-led intervention combining elements found in efficacy studies to lower BP, improved BP among patients with diabetes mellitus with persistent hypertension and poor refill adherence or insufficient medication intensification in 2 high-performing health systems.
  
  
  RESULTS
  We conducted a prospective, multisite cluster randomized pragmatic trial with randomization of 16 primary care teams at 5 medical centers (3 Veterans Affairs and 2 Kaiser Permanente) to the Adherence and Intensification of Medications intervention or usual care. The primary outcome was relative change in systolic BP (SBP), comparing 1797 intervention with 2303 control team patients, from 6 months preceding to 6 months after the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. The mean SBP decrease from 6 months before to 6 months after the intervention period was ≈9 mm Hg in both arms. Mean SBPs of eligible intervention patients were 2.4 mm Hg lower (95% CI: -3.4 to -1.5; P<0.001) immediately after the intervention than those achieved by control patients.
  
  
  CONCLUSIONS
  The Adherence and Intensification of Medications program more rapidly lowered SBPs among intervention patients, but usual-care patients achieved equally low SBP levels by 6 months after the intervention period. These findings show the importance of evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT00495794.
authors.affiliation: VA Center for Clinical Management Research (152), 2215 Fuller Rd, PO Box 130170, Ann Arbor, MI 48113-0170, USA. mheisler@umich.edu
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hofer
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: Mandi L
authors.initials: ML
authors.lastname: Klamerus
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Martin
authors.initials: M
authors.lastname: Bermann
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003376:Counseling / Q000379:methods; D048909:Diabetes Complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration*; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D015397:Program Evaluation; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents