Hypertension
Loren Bonner
CDC will soon take a proven pharmacist-led hypertension program and bring it to predominantly Black populations in the southeastern United States.
The program model, which originated at University of Michigan Health in Ann Arbor, includes specially trained pharmacists who work alongside a patient’s primary care physician. Patients with hypertension are seen for individualized BP control either at a primary care clinic or a community retail pharmacy—whichever is most accessible.
In 2019, CDC conducted a rigorous evaluation of the model, called the Michigan Medicine Hypertension Pharmacists’ Program (HPP), and found that the program improved BP control rates for participants. Specifically, CDC found that 66% of patients who met with an HPP pharmacist had their hypertension under control within 3 months, compared with 42% of patients who did not meet with a pharmacist. At the 6-month mark, 69% had their BP under control, compared with 56% of nonparticipants.
“Given the effectiveness of the program, we wanted to explore whether the program could be implemented in a different setting and achieve similar outcomes,” said a CDC spokesperson.
The agency chose the southeastern United States because it primarily serves Black populations at a higher risk of hypertension and uncontrolled BP. CDC is currently in the final stages of identifying a specific site for the program.
Hypertension affects nearly half of adults and 55% of Black adults, making it a major contributor to heart attacks and strokes, according to the American Heart Association. CDC has a goal to close this particular health disparity gap for Black adults by 5%.
After selecting a site in the southeastern region, CDC said it will provide training and support to help the program get up and running by the summer or fall of 2024.
“The goal of this effort is to understand whether the Michigan Medicine program can be implemented in a different setting with a different population and still achieve similar outcomes,” the CDC spokesperson said. “If the program is effective, the HPP could be used as a model to engage pharmacists in traditional clinical settings and community pharmacies in team-based care models to broaden access to health care and improve hypertension control.”
A model is born
HPP is almost 25 years old and has expanded over the years to include select Meijer store pharmacies near University of Michigan health clinics, where pharmacists are members of the care team.
Hae Mi Choe, PharmD, clinical professor at the University of Michigan College of Pharmacy and chief population health officer for University of Michigan Health, first developed the pharmacist-centric care model in 1999. By 2009, pharmacists were embedded at clinic locations at University of Michigan Health. There, pharmacists focused on treating diabetes, hypertension, and hyperlipidemia. Choe said she started with those three disease states because the literature supports strong outcomes when pharmacists are involved in the care for these areas specifically.
“Out of those three, hypertension bubbles to the top for a couple of reasons,” said Choe. Hypertension is controllable with the right combination of medication and lifestyle changes. “Blood pressure medication is effective if you stick with it, and the medications are affordable because they are mostly generics,” she said.
The statistics on hypertension are alarming. One out of two Americans have hypertension, and only one in four have it under control, according to CDC.
Operating within select Meijer store pharmacies
“I wanted to partner with Meijer to extend what we do in primacy care with pharmacists in the community to create more access for patients,” said Choe.
To provide continuity of care from the clinic to the community, specially trained Meijer pharmacists have access to the patient’s medical record. Patients are not obliged to fill their prescription at Meijer.
“It’s about the service, not the fill,” said Choe.
When a patient’s BP is elevated during the clinic visit, a trigger is created for a clinic staff member to ask the patient if they prefer to come into the clinic or to a Meijer store pharmacy for follow-up care.
“We were able to demonstrate similar success with blood pressure being managed at the Meijer stores,” Choe said.
When Choe and her colleagues did a survey of patient preferences from those who had the initial visit at Meijer, 82% picked a Meijer store for follow-up care.
Moving forward
Pharmacists are not new to patient care services. The novel piece of it all is putting the model into practice and building connections, said Choe.
“I would strongly recommend that community pharmacies partner with physician practices and not provide services disconnected from them,” Choe said. “It’s important to provide continuity of care so that the right hand knows what the left hand is doing.”
CDC plans to conduct a rigorous evaluation of the program at the new site once it’s up and running.
“We will be working with the site to use their electronic health record data to understand clinical outcomes related to the program,” said the CDC spokesperson. “We will also be conducting interviews with program staff to understand their approach to implementation and observing program implementation to ensure that it is happening as intended.” ■