Key result
A pharmacist-led transitional care clinic significantly reduced systolic blood pressure by 23 mmHg over 6 months in under-resourced patients with uncontrolled hypertension who completed all five visits.
Why the study?
The study was conducted to implement and evaluate a pharmacist-led hypertension program for under-resourced patients without a regular primary care provider discharged from the emergency department or screened at community health events.
Mean Difference: -23
p-value: p=0.002
A pharmacist-led transitional care clinic for under-resourced patients discharged from the ED significantly improved blood pressure control among those who completed the 6-month follow-up, though patient attrition was high.
Supports pharmacist-led transitional hypertension care in under-resourced settings; hypothesis-generating and requires RCT confirmation before practice change.
BACKGROUND: The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. METHODS: This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. RESULTS: There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). CONCLUSION: The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.
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Stewart et al. (2021) studied Hypertension (n=116). Pharmacist-led transitional care clinic (TCC) for hypertension management was evaluated on Change in systolic blood pressure from visit one to visit five (-23 mmHg, p=0.002). A pharmacist-led transitional care clinic significantly reduced systolic blood pressure by 23 mmHg over 6 months in under-resourced patients with uncontrolled hypertension who completed all five visits.
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