Blood Pressure
Sonya Collins
Clinicians may be hesitant to adjust a patient’s BP medications based on a single in-office reading. Stress, anxiety, extra caffeine, dehydration, and exercise can all cause a temporary BP spike. Even the race to get to the doctor’s appointment can set off triggers. But depending on patients to check their numbers at home presents another set of problems, including access to equipment and reliability of readings.
Pharmacist-led remote BP monitoring may address these concerns, according to a study published online on September 19, 2024, in the Journal of Pharmacy Practice.
“These data can get sent right to your doctor, and they can log in and see what things are like for the patient in the real world,” said Chris Johnson, PharmD, associate professor of pharmacy practice at the University of Arkansas for Medical Sciences and a coauthor of the study. “Things may sound great in the doctor’s office, or they may be a little off, but this way we can see how they’re actually doing at home with their medications and lifestyle changes.”
Twenty-one patients were included in the final analysis. The average reduction in systolic BP during the 6-month pilot study was 39 mm Hg. Just over two-thirds achieved the target BP of <140/<90 mm Hg.
Roughly three-quarters saw improvements in BP control. The majority saw a clinically significant reduction in BP.
“Developing relationships with them was helpful,” said Kaci Boehmer, PharmD, associate professor of pharmacy practice at the University of Arkansas for Medical Sciences and a coauthor of the study. “Part of why we saw these outcomes is that they felt like someone cared about them.”
The program
Thirty primary care patients with uncontrolled diabetes were enrolled in the pharmacist-led remote BP monitoring program. Physicians referred the patients, or pharmacists identified the patients through BP checks at the clinic. Each patient was taught to use a Wi-Fi–connected BP cuff that they took home with them. The devices left little room for patient error.
“The cuff is Velcro. You slide it on, push the button, and the monitor automatically sends the readings to the platform,” said Boehmer. The equipment was charged to the patient’s insurance.
Pharmacists requested daily BP checks up to two times a day. BP readings, which were uploaded to an online platform, were monitored by the two clinic pharmacists.
Pharmacists called patients weekly for 6 months. Through preapproved protocols, pharmacists adjusted patient medications and made other recommendations based on BP readings.
During weekly phone calls, the pharmacists ensured that the patients were using the cuffs correctly and addressed any barriers to taking readings twice a day.
They reviewed medication regimens with the patients; commended them in the areas where they were doing well; offered advice for improvements when appropriate; and explained any necessary medication changes.
Taking the time
A major reason patients’ BP was uncontrolled to begin with, Boehmer said, was due to a lack of understanding—whether it was about their medications, lifestyle changes, any insurance issues, or follow-up care.
“We were able to educate them, so they understood why they should care about their blood pressure, what the number means, what all these medications are for, and what to expect from them,” Boehmer said. “And they had us there to push them along or pat them on the back.”
While the study adds to untold evidence that pharmacist-led disease state management is effective, high-quality care, it also adds to evidence that there is not a clear and consistent way for pharmacists to get reimbursed for this type of care.
“We may need to figure out ways to utilize other professions, such as pharmacy technicians, to make the phone calls and collect the information,” Johnson said. “Reimbursement would be the main barrier to implementing this type of program.” ■