Pharmacist-physician teams improve patients' blood pressure control

Multidisciplinary teams offer a broader scope of clinical opinions that can change the face of healthcare. In the case of physician-pharmacist teams, blood pressure control at nine months was best among patients monitored by a team, with sustained improvement through 24 months among minorities.

Barry L. Carter, PharmD, of the University of Iowa in Iowa City, and colleagues utilized 32 medical offices in 15 states to carry out the prospective trial. The CAPTION (Collaboration Among Pharmacists and physicians To Improve Outcomes) study sought to expand recent research by bringing a pharmacist-inclusive blood pressure intervention to more sites and place a greater emphasis on recruiting minorities. The study began in 2010 and ended in 2013. The study was ended early due to financial constraints.

Research published online March 24 in Circulation: Cardiovascular Quality and Outcomes followed the outcome of 625 patients divided into three groups. Brief and sustained intervention groups received care that included regular follow-up from pharmacists to discuss issues and recommend adjustments to medication based on patient condition. The brief intervention received follow-up care with pharmacists through nine months; the sustained intervention group received follow-up with pharmacists through 24 months. The third group, a control, received usual care of periodic follow-up with physicians only.  

At nine months, more patients in the two combined intervention arms (43 percent) had controlled blood pressure compared with those receiving usual care (34 percent). However, Carter et al wrote that this finding was not statistically significant. While this primary outcome did not prove to be as successful as hoped, other outcomes were.

An analysis of adjusted mean systolic and diastolic blood pressure at nine months found that greater pharmacy management led to lower blood pressure. Also, while expected deterioration from improvement occurred among all patients regardless of group from 12 through 24 months, subgroup analysis found that regression towards high blood pressure was less likely among minority patients through 24 months in both the brief and sustained intervention groups. By 24 months, minority patients had an 8.2 and 9.2 mm Hg reduction in mean blood pressure in the brief and sustained groups, respectively. Nonminority patients had a mean blood pressure reduction at 24 months of 4.9 and 7.9 mm Hg for brief and sustained intervention, respectively.

Additional analysis found that utilizing 2014 hypertension guidelines, blood pressure control was achieved in 61 percent of intervention patients by nine months, compared to 45 percent of control subjects. At 24 months, blood pressure control in the brief, sustained intervention or control groups was 63 percent, 57 percent and 46 percent, respectively.

“These findings suggest that an established team-based care model involving pharmacists can be adopted in a large number of offices to reduce racial disparities in [blood pressure] control,” Carter et al wrote.