title: Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans.
abstract: Clinical pharmacists are utilized in Veterans Health Administration (VHA) facilities to assist with management of patients with chronic conditions including hypertension. The goal of this study was to examine blood pressure (BP) control after discontinuation of an intensive pharmacist-managed intervention. The study was conducted at a single Midwest VHA medical center and two affiliated community-based outpatient clinics. Patients with uncontrolled BP received an intensive pharmacist intervention for the first 6 months. Patients were then stratified based on whether their BP was controlled or not and were randomized to either continue the intervention for another 24 months (30 month total time period) or the intervention was discontinued following one-time receipt of educational materials. Mean systolic and diastolic BPs were reduced (P<.001) in diabetic patients (8.0±14.4 mm Hg and 4.0±9.1 mm Hg, respectively) and in nondiabetic patients (14.0±16.4 mm Hg and 5.0±10.0 mm Hg, respectively) following the 6-month intervention, with 54% of the total sample achieving BP control. BP control and the reduction in mean BP was maintained to a similar degree in both study groups at 12, 18, 24, and 30 months. There were no significant differences in BP at any of the follow-up periods in patients who did and did not receive the continued pharmacist intervention. This study found that BP control was maintained for at least 24 months following discontinuation of an intensive pharmacist intervention. These findings were seen in both the group that had a continued pharmacist intervention and in the group that had a one-time educational session when the intervention was discontinued. This study suggests that once BP control is achieved following a pharmacist intervention, patients can be referred back to their primary care provider for continued follow-up.
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA.|Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.|Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Barry L
authors.initials: BL
authors.lastname: Carter
authors.affiliation: Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.|Department of Internal Medicine, Division of General Internal Medicine, Carver College of Medicine, Iowa City, IA.|Department of Psychology, University of Iowa, Iowa City, IA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Vander Weg
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Parker
authors.affiliation: Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Cassie C
authors.initials: CC
authors.lastname: Goedken
authors.affiliation: Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Richardson
authors.affiliation: Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA.|Department of Internal Medicine, Division of General Internal Medicine, Carver College of Medicine, Iowa City, IA.|University of Iowa Institute for Clinical and Translational Science, Iowa City, IA.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Rosenthal
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D019468:Disease Management; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007484:Iowa; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010595:Pharmacists; D014728:Veterans