title: Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control.
abstract: BACKGROUND
  The purpose of this study was to evaluate if a physician/pharmacist collaborative model would be implemented as determined by improved blood pressure (BP) control in primary care medical offices with diverse geographic and patient characteristics and whether long-term BP control could be sustained.
  
  
  RESULTS
  Prospective, cluster-randomized trial of 32 primary care offices stratified and randomized to control, 9-month intervention (brief), and 24-month intervention (sustained). We enrolled 625 subjects with uncontrolled hypertension; 54% from racial/ethnic minority groups and 50% with diabetes mellitus or chronic kidney disease. The primary outcome of BP control at 9 months was 43% in intervention offices (n=401) compared with 34% in the control group (n=224; adjusted odds ratio, 1.57 [95% confidence interval, 0.99-2.50]; P=0.059). The adjusted difference in mean systolic/diastolic BP between the intervention and control groups for all subjects at 9 months was -6.1/-2.9 mm Hg (P=0.002 and P=0.005, respectively), and it was -6.4/-2.9 mm Hg (P=0.009 and P=0.044, respectively) in subjects from racial or ethnic minorities. BP control and mean BP were significantly improved in subjects from racial minorities in intervention offices at 18 and 24 months (P=0.048 to P<0.001) compared with the control group.
  
  
  CONCLUSIONS
  Although the results of the primary outcome (BP control) were negative, the key secondary end point (mean BP) was significantly improved in the intervention group. Thus, the findings for secondary end points suggest that team-based care using clinical pharmacists was implemented in diverse primary care offices and BP was reduced in subjects from racial minority groups.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00935077.
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.). barry-carter@uiowa.edu.
authors: Barry L
authors: BL
authors: Carter
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Christopher S
authors: CS
authors: Coffey
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Gail
authors: G
authors: Ardery
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Liz
authors: L
authors: Uribe
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Dixie
authors: D
authors: Ecklund
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Paul
authors: P
authors: James
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Brent
authors: B
authors: Egan
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Mark
authors: M
authors: Vander Weg
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Elizabeth
authors: E
authors: Chrischilles
authors: From the Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C., G.A.); Departments of Family Medicine (B.L.C., P.J.) and Internal Medicine (M.V.W.), Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City; Departments of Biostatistics (C.S.C., L.U., D.E.), Epidemiology (E.C.), and Health Management and Policy (T.V.), College of Public Health, University of Iowa, Iowa City; Department of Psychology (M.V.W.) and Organizations, Systems, and Community Health Area, College of Nursing (T.V.), University of Iowa, Iowa City; The Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City Veterans Administration, IA (B.L.C., M.V.W.); and Department of Internal Medicine, University of South Carolina School of Medicine, Greenville (B.E.).
authors: Thomas
authors: T
authors: Vaughn
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010595:Pharmacists; D011446:Prospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: hypertension; patient care team; pharmacists