5 | Summer 2016
effort to control blood pressure
among a diverse group of patients
was considered cost-effective,
with a $22 price tag to increase
the hypertension control rate by 1
percent, according to research in the American Heart
Association’s journal Hypertension.
“Previous studies have demonstrated the cost-effectiveness of collaborative hypertension control
programs. However, most lacked minority and low-income
populations,” said Linnea Polgreen, Ph.D., lead researcher
and an assistant professor in the Department of Pharmacy
Practice and Science at the University of Iowa.
In this study of 625 patients, 38 percent were black,
14 percent were Hispanic and 49 percent had an annual
household income less than $25,000.
Costs were assigned to medications, as well as
pharmacist and physician time. Cost-effectiveness ratios
were calculated based on changes in blood pressure
measurements and hypertension control rates.
Participants were from 32 medical offices in 15 states,
and all had uncontrolled high blood pressure, defined as
systolic pressure of 140 mm Hg or higher, or diastolic of 90
mm Hg or higher. Among those with diabetes or chronic
kidney disease, blood pressure was considered high at or
above 130 mm Hg systolic or 80 mm Hg diastolic.
Patients were randomized to a pharmacist-physician
intervention program for nine months or to a control group
receiving usual care.
The intervention included a clinical pharmacist reviewing
patients’ medical records, contacting them by phone and
regular face-to-face visits. The pharmacist created a care
plan and made recommendations to the physician to adjust
medication. In this study, the pharmacist worked in the
medical office and met face-to-face with physicians.
After nine months of the collaborative intervention:
• average systolic blood pressure was 6.1 mm Hg lower
• average diastolic pressure was 2.9 mm Hg lower
• hypertension control rate was 43 percent, compared to
34 percent in the control group.
“Patients in the intervention groups had higher costs
than those in the control group, but these costs were
mostly due to higher prescription drug costs — not the
cost of the pharmacist’s time,” Polgreen said. “On average,
the pharmacist spent about two hours per patient over the
course of the study.
“An unexpected finding was that the intervention group
had fewer physician visits, thus saving physician time for
other, more complex patient health problems.”
She noted that even for patients who regularly take their
medication, controlling blood pressure requires monitoring.
“In many clinics, especially in low-income areas, physicians
do not have the resources to monitor these patients.”
An estimated 42 percent of American adults have high
blood pressure, which is a major risk factor for heart disease
While the clinics in this study all had an in-house
pharmacist, Polgreen said people with uncontrolled high
blood pressure may want to ask their physician if they have
other team members in their office who could assist with
managing blood pressure.
Teaming Up to
WHEN PHARMACISTS AND PHYSICIANS
WORK TOGETHER, HIGH BLOOD PRESSURE
CAN BE LOWERED FOR LITTLE COST