title: Effectiveness of a Pharmacist-Physician Team-Based Collaboration to Improve Long-Term Blood Pressure Control at an Inner-City Safety-Net Clinic.
abstract: OBJECTIVE
  To evaluate the effectiveness of a pharmacist-physician collaborative practice model (PPCPM) to improve long-term blood pressure (BP) control rates in a primarily African-American underserved urban population.
  
  
  METHODS
  Volunteer physicians established initial diagnoses, whereas pharmacists provided most (more than 70%) of the medication management. During each scheduled visit, the pharmacist reconciled the medication list, completed a clinical interview, conducted a focused physical examination, developed and implemented a treatment plan, and provided documentation in a shared medical record.
  
  
  RESULTS
  A retrospective chart review was performed to collect data for a longitudinal cohort of patients managed by the PPCPM from 2010-2013.
  
  
  RESULTS
  Of 385 patients with at least two pharmacist visits during 2009, 172 patients received continuous care over the study period. At baseline, the mean age of the cohort was 51.3 years, 62% were female, and 76% were African-American. Approximately 65% were obese (body mass index 30 kg/m(2) or higher), and 39% were cigarette smokers. Mean baseline BP was 156/98 mm Hg, with only 17% of the cohort at their BP goal of lower than 140/90 mm Hg. The BP control rate improved to 66% during the first year and persisted throughout the study period, with 68% of patients at goal in 2013 (p<0.05 compared with baseline).
  
  
  CONCLUSIONS
  The PPCPM BP control rate ranks in the 90th percentile of National Committee for Quality Assurance benchmarks and was superior even to the 2013 reported mean for commercial insurers. The PPCPM effectively improved hypertension control in an uninsured, primarily African-American, urban population despite significant health barriers. Key elements of this asynchronous care model included access to a common medical record, optimization of distinct interprofessional roles, frequent follow-up with evaluation, and collaborative practice agreement with sufficient scope of practice to implement medication changes at the time of the visit.
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Sisson
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors.forename: Dave L
authors.initials: DL
authors.lastname: Dixon
authors.affiliation: Franciscan Hammond Clinic, Pharmacy, Munster, Indiana.
authors.forename: D Cole
authors.initials: DC
authors.lastname: Kildow
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Van Tassell
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, Virginia.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Carl
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors.forename: Della
authors.initials: D
authors.lastname: Varghese
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors.forename: Batul
authors.initials: B
authors.lastname: Electricwala
authors.affiliation: Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
authors.forename: Norman V
authors.initials: NV
authors.lastname: Carroll
mesh_terms: D001741:Black or African American; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D033183:Interdisciplinary Communication; D008297:Male; D008499:Medical Records; D008962:Models, Theoretical; D010348:Patient Care Team / Q000458:organization & administration*; D010595:Pharmacists / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D014505:Urban Population / Q000706:statistics & numerical data; D014768:Virginia
keywords: collaborative practice; hypertension; pharmacists; physicians