title: Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension.
abstract: OBJECTIVE
  Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists' work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists' work in the management of hypertension with a physician-pharmacist collaborative model.
  
  
  METHODS
  Descriptive analysis of the components of pharmacists' work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial.
  
  
  RESULTS
  This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists' work to understand pharmacists' relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients' blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point).
  
  
  CONCLUSIONS
  Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists' work in value-based financing and population management.
authors.affiliation: Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Isetts
authors.affiliation: College of Medicine and Pharmacy, University of South Florida, Tampa, Florida.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Buffington
authors.affiliation: The Patrick E. Keefe Professor in Pharmacy, The Department of Pharmacy Practice and Science College of Pharmacy, and Professor, The University of Iowa, Iowa City, Iowa.|Department of Family Medicine, The Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Barry L
authors.initials: BL
authors.lastname: Carter
authors.affiliation: Henry A. Palmer, Professor at the University of Connecticut School of Pharmacy, Storrs, Connecticut.
authors.forename: Marie
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa.
authors.forename: Linnea A
authors.initials: LA
authors.lastname: Polgreen
authors.affiliation: The Donald J. and Anna M. Ottilie Chair and Professor in the Department of Family Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Paul A
authors.initials: PA
authors.lastname: James
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D014487:Centers for Medicare and Medicaid Services, U.S.; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000191:economics; D003365:Costs and Cost Analysis; D016903:Drug Monitoring / Q000191:economics; D005260:Female; D017048:Health Care Costs; D000070497:Healthy Lifestyle; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D000070516:Intersectoral Collaboration; D008297:Male; D055118:Medication Adherence; D010348:Patient Care Team / Q000191:economics; D018802:Patient-Centered Care / Q000191:economics; D010595:Pharmacists / Q000191:economics; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D000078329:Workforce
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure control; hypertension management; pharmacist management