title: Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges.
abstract: BACKGROUND
  Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges.
  
  
  METHODS
  A prospective, controlled study was undertaken within the Australian primary care setting. Community pharmacists were recruited to one of three study groups: Group A (Control - usual care), Group B (Intervention), or Group C (Short Intervention). Pharmacists in Groups B and C delivered a service comprising screening and monitoring of BP, as well as addressing poor BP control through therapeutic adjustment and adherence strategies. Pharmacists in Group C delivered the shortened version of the service.
  
  
  RESULTS
  Significant changes to key outcome measures were observed in Group C: reduction in systolic and diastolic BPs at the 3-month visit (P<0.01 and P<0.01, respectively), improvement in medication adherence scores (P=0.01), and a slight improvement in quality of life (EQ-5D-3L Index) scores (P=0.91). There were no significant changes in Group B (the full intervention), and no differences in comparison to Group A (usual care). Pharmacists fed-back that patient recruitment was a key barrier to service implementation, highlighting the methodological implications of screening.
  
  
  CONCLUSIONS
  A collaborative, pharmacist-led hypertension management service can help monitor BP, improve medication adherence, and optimise therapy in a step-wise approach. However, blood pressure screening can effect behaviour change in patients, presenting methodological challenges in the evaluation of services in this context.
authors.affiliation: Academic Pharmacist and Associate Professor. Graduate School of Health - Pharmacy, University of Technology Sydney . Broadway, NSW ( Australia ). beata.bajorek@uts.edu.au.
authors.forename: Beata
authors.identifier: 0000-0002-2532-7187
authors.initials: B
authors.lastname: Bajorek
authors.affiliation: Woolcock Institute of Medical Research, University of Sydney . Glebe, NSW ( Australia ). kate.lemay@sydney.edu.au.
authors.forename: Kate S
authors.identifier: 0000-0002-2405-7365
authors.initials: KS
authors.lastname: Lemay
authors.affiliation: Academic General Practitioner and Conjoint Professor, Discipline of General Practice, University of Newcastle . Callaghan, NSW ( Australia ). parker.magin@newcastle.edu.au.
authors.forename: Parker
authors.identifier: 0000-0001-8071-8749
authors.initials: P
authors.lastname: Magin
authors.affiliation: Associate Professor in Primary Care and Medical Education. Sydney Medical School - Northern, Hornsby Ku-ring-Gai Hospital. Hornsby, NSW ( Australia ). christopher.roberts@sydney.edu.au.
authors.forename: Christopher
authors.identifier: 0000-0001-8613-682X
authors.initials: C
authors.lastname: Roberts
authors.affiliation: Professor of Pharmacy Practice. Faculty of Pharmacy, University of Sydney . Sydney, NSW ( Australia ). ines.krass@sydney.edu.au.
authors.forename: Ines
authors.identifier: 0000-0002-0466-9807
authors.initials: I
authors.lastname: Krass
authors.affiliation: Professor of Pharmacology and Executive Director Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Woolcock Institute of Medical Research, University of Sydney . Glebe, NSW ( Australia ). carol.armour@sydney.edu.au.
authors.forename: Carol L
authors.identifier: 0000-0002-2930-2227
authors.initials: CL
authors.lastname: Armour
keywords: Australia; Community Pharmacy Services; Hypertension; Interprofessional Relations; Medication Adherence; Medication Therapy Management; Methodology