Pharmacists’ contributions to hypertension control go beyond dispensing, Surgeon General says
Pharmacists got support from high places in a new resource aimed at creating comprehensive strategies to treat, control, and prevent hypertension (HTN). The Surgeon General’s Call to Action to Control Hypertension, or simply Call to Action (CTA), emphasizes pharmacists’ value to HTN efforts, as well as obstacles to their participation. The report is an initiative of U.S. Surgeon General Jerome Adams, MD, MPH, and was released in October 2020. Access the report at http://apha.us/CTA_HTN.
While research has shown that certain HTN strategies are effective—promoting self-measured blood pressure monitoring, using electronic health records to improve clinical workflow and provide clinical decision support tools, building integrated care teams, among others—expanding, tailoring, and replicating them has been a challenge. United States HTN statistics remain sobering and largely static. HTN affects one in two American adults; in 71% of those with identified HTN who have received lifestyle recommendations and take medication, the condition is still uncontrolled.
In CTA, Adams targets social determinants of health, as well as psychosocial factors like job loss and depression that have worsened during the COVID-19 pandemic, as crucial considerations in the development and use of tangible and specific interventions that overcome health inequity. It outlines three primary goals: make HTN a national priority; ensure that the places where people live, learn, work, and play support HTN control; and optimize patient care for HTN control.
More than dispensing
The report gets straight to the point. “Pharmacies should not simply be considered a way to distribute medication,” the report reads. “Community-based pharmacists can support [HTN] management in meaningful ways, including being integral members of care teams through collaborative practice agreements with local health care practices and health systems.” The Surgeon General’s call to action highlights pharmacist-provided medication therapy management (MTM) services to reconcile medication regimens, support adherence, and recommend or adjust medications to help patients lower their blood pressure.
“Where allowed by law, medication change protocols for nurses, pharmacists, and other team members are recommended to ensure that each team member’s activities within his or her scope of practice are being maximized,” the report reads.
One strategy to achieve the second goal, creating community supports for HTN control, involves linking clinical services and community programs. Some of these activities could lead to the pursuit of HTN management care outside of the traditional primary care setting; for example, visiting pharmacies for MTM. The widespread availability of free blood pressure machines in pharmacies make them a natural site for HTN education and referrals to other health professionals, when appropriate.
And of course, the report calls for multidisciplinary care teams that include pharmacists—which evidence has shown improves HTN control. Beyond MTM services, “clinicians can coordinate with pharmacists directly through large health systems or in the community through collaborative practice agreements. Including pharmacists in community-based efforts to improve hypertension control among underserved populations through active medication management has also proved promising and could be implemented in an alternative care model to enhance traditional primary care.”
The report calls attention to how a lack of payment mechanism for pharmacists’ services hinders a national effort to fight HTN. “One challenge to establishing care teams, however, is that reimbursement models are not always in place to support their use, especially when teams include nontraditional members such as pharmacists and community health workers,” the report reads.
The report recommends that health plans and managed care organizations tackle these barriers by implementing payment models that reinforce the use of guideline-based, high-value care.