Pharmacist's pilot blood pressure program takes root at Wegmans
In counseling patients with high blood pressure, Chris Gardiner, PharmD, tends to look for that sudden “Aha!” moment when it finally dawns on them that they have it within their own power to lower their risk for a major cardiovascular event.
“I had a gentleman who came in with his young son,” recalled Gardiner, who is a Divisional Wellness Coordinator and corporate health care analyst for Wegmans Food Markets, an 83-store food and pharmacy retailer based in Rochester, NY. “When I told him he was eight times more likely to die of a heart attack than a person with normal blood pressure, his eyes opened very wide. He looked down at his son and said, ‘What do I need to do to get this number down?’ That’s when we started talking about goals.”
Gardiner has been advising patients on blood pressure reduction goals for the last 5 years, ever since he was a young store-level pharmacist fresh from a community pharmacy residency at the University of Maryland operated in partnership with Walgreens. He persuaded his divisional and corporate pharmacy supervisors at Wegmans that a pharmacist-managed pilot program for employees with hypertension at his Liverpool, NY, store might help to improve their health and maybe even reduce sick days and costly hospitalizations.
The success of his modest 2008 start-up, which demonstrated an overall 19-point reduction in systolic blood pressure among the 102 employees who signed up for counseling sessions (out of 732 who were screened and 330 who were found to be at risk), led to the program’s expansion to other Syracuse-division locations and finally to a companywide rollout.
Christopher Gardiner, PharmD, was inspired to educate and motivate Wegmans's employees by creating the company's blood pressure wellness program.
Pharmacists as wellness champions
Today, 90% of Wegmans’s more than 34,000 eligible employees have been screened by pharmacists as part of the company’s “Know Your Blood Pressure” campaign, said Brian Pompo, BSPharm, the company’s Coordinator of Wellness and Clinical Services. Since the program’s expansion, he said, some 4,100 of those with hypertension (blood pressure ≥140/90 mm Hg) or prehypertension (120–139/80–89 mm Hg) have enrolled in a six-session blood pressure management program run by pharmacist “store wellness champions.”
Dan Ferrara, BSPharm, the Vice President of Pharmacy Operations at Wegmans, said the wellness champion concept was inaugurated a few years ago when the company first began shifting pharmacists away from a total emphasis on production to a more clinically oriented role. He said pharmacists designated as wellness champions were expected to “own” the pharmacy’s patient care programs, but all pharmacists, he added, are involved to some degree in clinical activities ranging from patient immunizations to health screenings.
“The shifting role of pharmacists is something that we take very seriously,” Ferrara said. “Everything we do from workflow to the physical layout of our pharmacies to scheduling to our labor model is all tied to trying to free up pharmacists to do what they went to school for.”
A centralized filling operation, for example, has reduced store prescription production by nearly one-half, he said, and a telephone support center fields most of the calls that can consume so much of a pharmacist’s day. “We try to drive as much production as possible out of the stores,” Ferrara said.
With more time to focus on the company’s signature employee blood pressure program, pharmacists have been able to show that the early reductions achieved in Gardiner’s pilot were more than just a flash in the pan. A white paper coauthored earlier this year by Pompo and James DiNicolantonio, PharmD, wellness champion at Wegmans’s Ithaca store, reported aggregate reductions of 17 points and 6 points in systolic and diastolic blood pressure levels, respectively, among 1,119 employees with blood pressures of 140/90 mm Hg or greater.
Wegmans's wellness champions are trained to perform manual blood pressure measurements.
Accountability through caring
Pharmacists’ methods to engage patients in taking charge of their own lifestyle changes and medication adherence may have undergone some individual fine-tuning over the years, but the basic approach has remained fairly constant ever since Gardiner first began to set up a table in a high-traffic employee area of Wegmans’s Taft Road store in Liverpool and invite fellow employees to sit down and have their blood pressures tested.
Ferrara told Pharmacy Today that Gardiner was particularly adept at persuading coworkers that “knowing their numbers” was a good start toward improving their health. He said that Gardiner’s “secret sauce” is his ability to make people realize that he really cares for them, “and that caring leads them to be accountable” for their own health and well-being. The company has since adopted “accountability through caring” as the watchword for the kind of customer interactions it seeks to encourage.
During those early pilot program days, employee screenings would be advertised via time-clock signage, word-of-mouth at store-department manager meetings, and overhead announcements on screening days. Anywhere from 20 to 100 employees might sit down for a blood pressure check.
“If a reading came out with an at-risk number,” Gardiner said, “I’d wait about 5 minutes, get a good conversation going, and then check it a second time. The main thing was to take the measurement, let them know the potential risks, and get them in contact with whatever help they needed, whether that meant coming back to the pharmacy and helping them with lifestyle goals or putting them in touch with their primary care provider for medication.”
Many of the at-risk patients agreed to sit down with Gardiner in a series of counseling sessions. In a first, longer session, he would focus on overall risk assessment and the rationale for the lifestyle changes and medication therapy that could lead to better health. In follow-up encounters, Gardiner would check on results and reinforce earlier messages. He and the coworker would find an area in the store where they could talk in privacy about the choices for change.
“It wasn’t that we were only looking to medication as a solution, although obviously that would reduce their risk,” he said. “We were also helping them to change some of their lifestyle choices, with weight and diet being the biggest factors. The goals were always the participant’s choice. We were there for support and encouragement.”
Wegmans developed wallet-sized cards for employees to measure progress.
Gardiner helps employees see benefits of lifestyle changes.
Wegmans has blood pressure machines in all stores.
Partnering with nutritionists, launching other initiatives
The emphasis on healthy nutrition and the importance of losing weight in blood pressure management fit in neatly with Wegmans’s “Eat Well Live Well” campaign. Ferrara said that the company’s team of nutritionists was an important partner in many of the pharmacy’s clinical initiatives, including health screenings and blood pressure reduction programs. “We like to say that the best medicine is the food you eat,” he said.
Brian Pompo noted that he sits in on nutritionists’ meetings as the pharmacy representative and was part of the team that developed Wegmans’s fact-filled “Eat Well, Live Well for Lower Blood Pressure” brochure. “We’ve moved away from silos and started working more collaboratively with other business units,” he said.
Brian Pompo, BSPharm, oversaw the expansion of the program to all Wegmans stores.
The blood pressure program’s success has been followed by decisions to launch other pharmacist-run clinical programs, including the imminent rollout of a pilot cardiovascular risk–reduction initiative that would be layered on top of the blood pressure program and the introduction of a diabetes management initiative in 2014.
The blood pressure reduction program has also been used as a platform for reaching out to a wider community. So far, two major local employers, one in Rochester and the other in Buffalo, have agreed to use Wegmans’s pharmacists in a blood pressure management program for employees similar to the one operated by the retailer for its own workers. As of last October, a total of 45 employees were enrolled in the two programs.
Blood pressure reduction is not the only benefit that the Wegmans program has produced. “We’ve seen that folks who focus on one component of disease risk, whether hypertension or something else, work toward getting all of their measures in check,” said Pompo. “Whether diabetes, weight, or smoking, we have the ability to connect them with services that Wegmans provides to help them along the way.”
The empowerment of pharmacists as clinical specialists has also helped to promote retention. Ferrara noted that only 1 individual out of the company’s more than 440 pharmacists has left in the last 3 years to join another community pharmacy program.
A week or so after the interview, Gardiner e-mailed a note to Pharmacy Today that went further in explaining his “passion” for the profession that has motivated him ever since his first year at the Albany College of Pharmacy and member of the APhA Academy of Student Pharmacists.
“When I first started this project,” he wrote, “it was rewarding as a health care professional to personally help each employee achieve their blood pressure and health-related goals. To be part of the program’s expansion and see over 1,000 high-risk individuals reduce their systolic blood pressure by nearly 20 points affords me a sense of achievement and pride in my profession that I never knew possible.”
Tips: Building a thriving clinical practice
In our talks with Chris Gardiner, Dan Ferrara, and Brian Pompo, Pharmacy Today took away a number of practical suggestions that might help other pharmacists who want to build a thriving clinical practice:
- Even before starting out, they agreed, get the “buy-in” from all management levels. Wegmans’s patient care programs, for example, have had the enthusiastic endorsement of the Wegman family itself on down through the company’s divisional management ranks.
- Build patient rapport not only through caring encounters but also by offering practical takeaway materials to help patients stay on track between sessions. During initial meetings, for example, Gardiner accessed the American Heart Association’s High Blood Pressure Health Risk Calculator with his laptop computer (www.heart.org/beatyourrisk/en_US/hbpRiskCalc.html) and used it to record patients’ likelihood of developing cardiovascular disease. “It’s a great visual tool,” he said.
- Document patient outcomes. Gardiner developed his own app to record blood pressure results. The company has since licensed a MirixaEdge program from Mirixa Corporation to manage its portfolio of disease-management programs.
- Start small, and don’t expect major successes at the outset. “Remember that it’s truly a marathon and not a sprint,” said Pompo.
- In launching a program for fellow employees, come up with incentives that will bring them to the table. Wegmans offered $6 meal vouchers to induce employees to join the “Know Your Blood Pressure” program. In the end, however, it was the caring involvement of a pharmacist that kept patients coming back.