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Physician-pharmacist collaboration increases medication intensification
Medication intensification increased in the primary care setting when physicians and pharmacists collaboratively intervened in patients’ BP management, according to results of a recent study.
However, the physician-pharmacist collaborative management model (PPCM) failed to increase medication adherence, researchers reported in the Journal of the American Society of Hypertension.
For the CAPTION trial, Tyler H. Gums, PharmD, from the department of pharmacy practice and science and the department of family medicine at the University of Iowa, and colleagues randomly implemented a PPCM or usual care in 32 primary care offices across 15 states that staffed at least one pharmacist. The researchers then compared medication adherence and intensification in 539 patients (52.7% minorities) who were randomly assigned to a 9- or 24-month intervention (n = 345) or usual care.
Physicians and pharmacists in the PPCM group attended regional training programs to learn to implement the intervention effectively. Pharmacists were encouraged to assess patients’ knowledge of BP medication, discuss potential contraindications and educate patients on the importance of adherence by providing them with written lifestyle materials, a wallet card listing of doses and a contact phone number with BP goals. The pharmacists were also urged to meet with patients at 1, 2, 4, 6 and 8 months; additional appointments plus biweekly telephone calls were suggested for patients with uncontrolled BP. As part of the intervention, pharmacists recommended more intensive dosages and additional antihypertensive medications to physicians when needed.
The current findings are limited to the first 9 months of the study period. On average, patients in the 9-month intervention group met with pharmacists 5.2 times and patients in the 24-month intervention group met with pharmacists 4.5 times.
BP control was 43% in the intervention group compared with 34% in the usual-care group (adjusted OR = 1.57; 95% CI, 0.99-2.5). Mean BP decreased by 6.1/2.9 mm Hg more among patients who received collaborative care vs. those who received usual care. The researchers estimated that the reduction in BP could lower stroke mortality by 23% based on the Hypertension Detection and Follow-up Program.
Physicians accepted nearly all of the pharmacists’ recommendations. Patients in the intervention group had significantly more medication changes (4.9 vs. 1.1; P = .0003) and increased use of diuretics and aldosterone antagonists (spironolactone) compared with patients who received usual care (P = .01). However, adjusted results demonstrated that medication intensification had no effect on systolic or diastolic BP.
Furthermore, nonadherence assessed by a six-question survey revealed a nonsignificant difference between patients in the intervention vs. usual care groups (5.5% vs. 8.8%).
“The gap in our knowledge includes the specific mechanisms by which team-based care are effective, which strategies will optimize clinical pharmacy services, and how the PPCM potency can be further increased, especially related to optimal strategies to identify and resolve non-adherence to medications,” Gums and colleagues wrote. – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.