Physician-Pharmacist Collaborative Management: Narrowing the Socioeconomic Blood Pressure Gap.
Physician-pharmacist collaboration improves blood pressure, but there is little information on whether this model can reduce the gap in healthcare disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate whether the pharmacist intervention could reduce healthcare disparities by improving blood pressure in high-risk racial and socioeconomic subjects compared with the control group. The analyses in minority subjects were prespecified secondary analyses, but all other comparisons were secondary, post hoc analyses. The 9-month visit was completed by 539 patients: 345 received the intervention, and 194 were in the control group. Following the intervention, mean systolic blood pressure was found to be 7.3 mm Hg (95% confidence interval 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared with the control group (P=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% confidence interval 3.2, 13.1) lower than the control group with lower education (P=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid, or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. Although disparities in blood pressure were reduced by the intervention, there were still nonsignificant gaps in mean systolic blood pressure when compared with intervention subjects not at risk.



URL: http://clinicaltrials.gov. Unique identifier: NCT00935077.
From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.).
Maxwell D
MD
Anderegg
From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.).
Tyler H
TH
Gums
From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.).
Liz
L
Uribe
From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.).
Christopher S
CS
Coffey
From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.).
Paul A
PA
James
From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa; and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.). barry-carter@uiowa.edu.
Barry L
BL
Carter
D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use*; D001795:Blood Pressure Determination; D005260:Female; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010595:Pharmacists / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014481:United States
D000959:Antihypertensive Agents
blood pressure; healthcare disparities; minority populations; pharmacist intervention; team care