EHR
Sonya Collins
Almost half of American adults have a diagnosis of hypertension. But only one in four of these nearly 108 million people have their blood pressure (BP) under control. While the outcomes of pharmacist-managed hypertension are well-established, reaching the patients who would benefit from such care can be a challenge.
A recent study in the American Journal of Managed Care describes a novel approach to capturing patients through an electronic health record (EHR) for enrollment in the chronic medication optimization pharmacist (CMOP) program. Compared to those in usual care, patients in the pharmacist-led ambulatory care intervention were more likely to lower their BP to goal level and to do so faster.
The study underscores the role pharmacists can play in disease state management and highlights a novel way of identifying patients in need.
“Community pharmacists who have the resources, staff, and time are positioned in a great way to help patients with hypertension because they interact frequently with these high-risk patient populations that may not routinely seek follow-up care with their PCP [primary care physician],” said Kristin Soreide, PharmD, who coauthored the study while in practice at Henry Ford Health System in Detroit. “With the growing shortage of PCPs, we’re in a perfect position to help by managing these chronic disease states to improve blood pressure and other outcomes,” she said.
A novel approach
CMOP connected pharmacists with patients in two ways: via traditional physician referrals or through the health system’s EHR. A data analytics tool linked to the EHR identified patients who had BP readings greater than 140/90 and flagged them for pharmacist outreach.
“One reason this tool is so great is because with it pharmacists are able to identify patients who don’t routinely seek follow-up care with their PCP, who are at risk of loss to follow up, or for whom it would be hard to take time off and attend doctors’ visits. Pharmacists can see if these patients would like to work with them to help achieve their blood pressure goal,” Soreide said.
Some studies that assess pharmacist-management of hypertension, Soreide added, may not serve patients who lack smartphone access or digital literacy.
“A lot of trials show that including a pharmacist improves hypertension outcomes, but many of them use telehealth monitoring or smartphone-based applications that may not reach everyone.”
The CMOP program
The researchers enrolled 222 patients in the study: 111 in the CMOP intervention and 111 in the usual care group.Patients enrolled in the pharmacist-led program had an initial hour-long visit with a pharmacist followed by 30-minute visits every 2 to 4 weeks. They remained in the program until they achieved their BP goal.
At the initial visit, the pharmacist took BP, assessed medication adherence, adjusted doses or added new medication as needed, and counseled on diet and lifestyle. Patients who were not adherent to the medication regimens at the start of care got counseling and practical assistance such as pillboxes, delivery services, and medication switches that might improve adherence.
“The majority of pharmacists’ time was spent optimizing blood pressure medication,” Soreide said. “CMOP pharmacists were more likely to add a new hypertensive agent and/or increase the dosage of a current agent compared to the usual care group, which didn’t make as many medication adjustments.”
Study findings
Six months into the program, 69.4% of CMOP patients had reached their goal BP compared to 42.3% of usual care patients. CMOP patients, whether referred by a physician or identified through EHR, achieved their goal BP faster than their usual care counterparts. CMOP patients also had more visits in the time it took to reach their goal.
While patients in the pharmacist-led program were on more medications, and had undergone more dosage changes, by the end of the program, they had also become more adherent. Just over half (50.4%) of patients under a pharmacist’s care were adherent to their medication regimens at baseline. At 6 months, 72.1% were adherent.
Raising the profile of the pharmacy profession
In the face of a growing PCP shortage, the need for pharmacist-led disease state management in an ambulatory care setting persists, Soreide said. But a number of barriers related to provider status and reimbursement stand between pharmacists and the patients who could benefit from their care.
Pharmacists must continue to raise awareness of their expertise in this area. “There’s both patient and provider perceptions of who pharmacists are and what we do,” Soreide said. “It’s essential to educate patients and providers about how we are the medication experts, and we can manage these chronic disease states.” ■