Impact of pharmacist involvement on blood pressure outcomes following nurse blood pressure visits

BACKGROUND: Hypertension is a major modifiable risk factor for cardiovascular (CV) disease. National hypertension guidelines recommend a blood pressure (BP) goal of <130/80 mmHg to reduce CV risk. Existing literature has demonstrated that pharmacist involvement in BP management contributes to positive outcomes. Continuing to expand workflows that incorporate pharmacists in an efficient manner would be beneficial. OBJECTIVE: To evaluate the impact of a modified workflow related to pharmacist involvement in nurse BP visits. PRACTICE DESCRIPTION: Usual workflow consisted of provider review of patient chart after the nurse BP visit and provider plan development. PRACTICE INNOVATION: In this modified workflow, the patient chart from the nurse BP visit was routed to a pharmacist if the BP was elevated. After chart review, the pharmacist would provide recommendations to the provider for review and approval. EVALUATION METHODS: This was a retrospective, prepost intervention study that took place at multiple primary care sites. The population included adults 18-79 year old with a baseline systolic blood pressure (SBP) 131-179 mmHg or diastolic blood pressure (DBP) 81-109 mmHg. RESULTS: The absolute difference in BP from the initial nurse visit to the first primary care follow-up visit was 8.1 mmHg (95% CI 4.8-11.3; P value <0.001) for SBP and 4.7 mmHg (95% CI 3.0-6.5; P value <0.001) for DBP. Over half of the patients (53.4%) achieved BP of <140/90 mmHg at the first primary care follow-up visit. There were a total of 143 pharmacist interventions, most often consisting of medication dose increases, medication initiations, and/or lab orders. CONCLUSION: This workflow demonstrated that pharmacist interventions within the nurse BP workflow can contribute to improvement in BP without requiring a comprehensive pharmacist visit.