What does this research mean for the field?

Physician/pharmacist collaboration significantly improves blood pressure control at 9 months in patients with uncontrolled hypertension compared to standard care. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This trial evaluates the effectiveness of pharmacist recommendations for improving blood pressure control in patients with uncontrolled hypertension.

April 1, 2008Journal of Clinical HypertensionOpen Access

A Cluster Randomized Trial to Evaluate Physician/Pharmacist Collaboration to Improve Blood Pressure Control

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Uncontrolled hypertension (n=179). Intervention: Physician/pharmacist collaboration vs. Control (usual care with educational lectures for physicians and written information for patients). Primary outcome: Blood pressure control at 9 months (OR 8.9, 95% CI 3.8-20.7, p=<.001).

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Key result

Physician/pharmacist collaboration significantly improved blood pressure control at 9 months compared to control (89.1% vs 52.9%, OR 8.9).

Why the study?

Does physician/pharmacist collaboration improve blood pressure control in patients with uncontrolled hypertension?

Population

179 adults aged 21 to 85 years with uncontrolled hypertension. Excluded: BP medication change within 4…

Comparison

Physician/pharmacist collaboration. Clinical… vs Usual care. Patients in control clinics received…

Design

RCT, Randomization of clinics was performed using a table of random numbers…

Follow-up

9 months

Authors

BCBarry L. CarterPreventive Cardiology GBGeorge BergusUniversity of Iowa JDJeffrey D. DawsonUniversity of Iowa

Discussion

Member takes

Implication

Supports physician-pharmacist collaboration for uncontrolled hypertension; extends RCT evidence for team-based care models.

Key Points

This trial evaluates the effectiveness of pharmacist recommendations for improving blood pressure control in patients with uncontrolled hypertension.
Cluster randomized controlled trial involving patients with uncontrolled hypertension aged 21 to 85 years.
Pharmacists made recommendations to physicians in intervention clinics (n=101) but not in control clinics (n=78).
Follow-up duration was 9 months, measuring systolic and diastolic blood pressure changes.
Mean systolic blood pressure decreased by 8.7 mm Hg (95% CI, 4.4-12.9) in the intervention group compared to control.
Diastolic blood pressure showed a mean reduction of 5.4 mm Hg (CI, 2.8-8.0) at 9 months in the intervention group.
BP was controlled in 89.1% of patients in the intervention group compared to 52.9% in the control group (adjusted odds ratio, 8.9; CI, 3.8-20.7; P<.001).

Study Design

Type

RCT (n=179)

Blinding

Open-label with blinded outcome assessment

Randomization

Cluster randomized

Multicenter

Yes

Structured PICO

Does physician/pharmacist collaboration improve blood pressure control in patients with uncontrolled hypertension?

Population

179 adults aged 21 to 85 years (mean age 61) with uncontrolled hypertension (clinic SBP 145-179 mm Hg or DBP 95-109 mm Hg; or 135-179/85-109 mm Hg if diabetic). Excluded: BP medication change within 4 weeks, stage 3 hypertension (>180/110 mm Hg), recent MI or stroke within 6 months, NYHA class III or IV congestive heart failure, unstable angina, serious renal or hepatic disease, pregnancy, poor prognosis, dementia, or cognitive impairment.

Intervention

Physician/pharmacist collaboration. Clinical pharmacists interviewed patients at baseline, assessed regimens, suggested goal BP, and provided recommendations to physicians to intensify medication therapy (e.g., adding thiazide diuretics, increasing doses) and improve patient adherence over 9 months.

Comparator

Usual care. Patients in control clinics received care from physicians only, and clinical pharmacists abstained from making recommendations for these patients.

Outcome

Difference in systolic and diastolic blood pressure (clinic and 24-hour levels) and overall BP control rates at 9 months.surrogate

Main Result

Effect estimate: OR 8.9 (95% CI 3.8-20.7)

Absolute Event Rate: 89.1% vs 52.9%

p-value: p=<.001

Physician/pharmacist collaboration significantly improves blood pressure control in patients with hypertension by intensifying medication therapy and improving adherence.

Limitations

The control group received increased surveillance and education, so it cannot be considered strict usual care.
It is unknown if the intervention effect would wane over a longer follow-up period.

Cite This Study

Carter et al. (2008) conducted an RCT in Uncontrolled hypertension (n=179). Physician/pharmacist collaboration vs. Control (usual care with educational lectures for physicians and written information for patients) was evaluated on Blood pressure control at 9 months (OR 8.9, 95% CI 3.8-20.7, p=<.001). Physician/pharmacist collaboration significantly improved blood pressure control at 9 months compared to control (89.1% vs 52.9%, OR 8.9).

synapsesocial.com/papers/6a181dbb56b3e2ada412eb2f https://doi.org/10.1111/j.1751-7176.2008.07434.x

Topics

Hypertension management

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A Cluster Randomized Trial to Evaluate Physician/Pharmacist Collaboration to Improve Blood Pressure Control

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

A Cluster Randomized Trial to Evaluate Physician/Pharmacist Collaboration to Improve Blood Pressure Control

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider