title: Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial.
abstract: OBJECTIVE
  To assess the effectiveness and sustainability of a 6-month Team Education and Adherence Monitoring (TEAM) intervention for black patients with hypertension in community chain pharmacies.
  
  
  METHODS
  Cluster randomized trial.
  
  
  METHODS
  28 chain pharmacies (14 TEAM and 14 control) in five Wisconsin cities from December 2006 to February 2009.
  
  
  METHODS
  576 black patients with hypertension.
  
  
  METHODS
  Trained pharmacist-technician teams implemented a 6-month intervention using scheduled visits, Brief Medication Questionnaires (BMQs), and novel toolkits for facilitating medication adherence and pharmacist feedback to patients and physicians. Control participants received patient information only.
  
  
  METHODS
  Refill adherence (≥80% days covered) and changes in systolic blood pressure (SBP), diastolic blood pressure, and blood pressure control using blinded assessments at 6 and 12 months.
  
  
  RESULTS
  At baseline, all patients had blood pressure of 140/90 mm Hg or more. Of those eligible, 79% activated the intervention (mean 4.25 visits). Compared with control participants at 6 months, TEAM participants achieved greater improvements in refill adherence (60% vs. 34%, P < 0.001), SBP (-12.62 vs. -5.31 mm Hg, P < 0.001), and blood pressure control (50% vs. 36%, P = 0.01). Six months after intervention discontinuation, TEAM participants showed sustained improvements in refill adherence ( P < 0.001) and SBP ( P = 0.004), though the difference in blood pressure control was not significant ( P < 0.05) compared with control participants. Analysis of intervention fidelity showed that patients who received the full intervention during months 1 through 6 achieved significantly greater 6- and 12-month improvements in refill adherence and blood pressure control compared with control participants.
  
  
  CONCLUSIONS
  A team-based intervention involving community chain pharmacists, pharmacy technicians, and novel toolkits led to significant and sustained improvements in refill adherence and SBP in black patients with hypertension.
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Svarstad
authors.forename: Jane Morley
authors.initials: JM
authors.lastname: Kotchen
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
authors.forename: Roger L
authors.initials: RL
authors.lastname: Brown
authors.forename: Stephanie Y
authors.initials: SY
authors.lastname: Crawford
authors.forename: Jeanine K
authors.initials: JK
authors.lastname: Mount
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Palmer
authors.forename: Eva M
authors.initials: EM
authors.lastname: Vivian
authors.forename: Dale A
authors.initials: DA
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D016000:Cluster Analysis; D003157:Community Pharmacy Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods; D010595:Pharmacists / Q000458:organization & administration*; D010596:Pharmacy Technicians / Q000458:organization & administration; D024382:Professional Role; D013997:Time Factors; D014922:Wisconsin
chemical_list: D000959:Antihypertensive Agents
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