Project IMPACT: Hypertension
Over 74 million Americans have elevated blood pressure that warrants treatment.9 Uncontrolled hypertension leads to end stage renal disease, heart failure, myocardial infarction, stroke, and is the number one attributable risk factor for death throughout the world. Despite understanding the risks associated with hypertension, approximately 30 percent of adults are still unaware that they have hypertension, greater than 40 percent of individuals with hypertension are not being treated, and two-thirds of hypertensive patients on medical therapy are not being controlled to their optimal blood pressure goals.10 Non-adherence to lifestyle changes and medications has been identified as a barrier to optimal antihypertensive therapy.
Read the entire manuscript here.
The Background
Pharmacists are in a unique position to provide education to patients with hypertension and to implement other strategies to improve adherence to lifestyle changes and medication regimens. Project ImPACT: Hypertension equips patients with unique home blood pressure monitoring devices that can wirelessly transmit readings to the pharmacy computer. This information was used by the pharmacist when assembling a complete understanding of that patient’s blood pressure control.
Incorporating home blood pressure monitoring provides the pharmacist with the unique teaching opportunity of relating treatment and monitoring with patient goal setting.
Key Objectives of Project ImPACT: Hypertension were to:
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Assist identified patients with hypertension in achieving national treatment goals;
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Increase nutritional, exercise, and weight loss goal setting among patients with hypertension;
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Improve participant adherence to medication therapy;
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Improve patient knowledge and health satisfaction; and,
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Modify cardiovascular risk factors.
The Participants
Patients
University employees were eligible for this service if they were self-identified as having a diagnosis of hypertension or pre-hypertension. Patients did not qualify for this service if they were pregnant, nursing, under 18, or over 89 years of age. 152 patients who are part of the Wayne State Wellness Warriors Program participated in Project ImPACT: Hypertension.
Pharmacy
University Pharmacy, an independently owned and operated community pharmacy on the campus of Wayne State University in Detroit, Michigan. Maria Young, owner and pharmacist, provided care and was assisted by numerous student pharmacists. Pharmacists and student pharmacists who were involved in the service were required to complete a training module and pass a competency exam.
The Methods
Participants enrolled in the pharmacy hypertension service met with the pharmacist or student pharmacist 4 times over a 6 month period at the University Pharmacy. Prior to the first visit participants completed a medical intake form and a knowledge survey. Patients received a home blood pressure monitor that was capable of wirelessly transmitting readings to the pharmacy. The first visit was 45-60 minutes and subsequent visits were 15-30 minutes each.
Pharmacists Visits
The majority of time during each visit was dedicated to:
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education and coaching about blood pressure, lifestyle modifications, and adherence;
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goal setting; and
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clinical assessment of the patient’s progress.
This data was recorded on a visit encounter form with any medication-related concerns identified by the pharmacist or student pharmacist, how they were addressed in the therapeutic plan, and the status of their resolution. Written letters were used to communicate directly with physicians. Patient education materials compiled by the American Heart Association and the National Institutes of Health were also provided to all participants.
At the end of the 6 months or after 4 visits, participants completed another knowledge and health satisfaction survey with additional questions regarding their perception of pharmacy services.
Innovation
In addition to regularly using their home blood pressure monitors, patients were instructed to keep a diary about activities that may have impacted any out-of-range blood pressure readings. At each visit, the patient brought in the blood pressure devices and the pharmacist uploaded the data onto the pharmacy computer. A software program created a graph marked with color indicators to visually represent the patient’s readings in relation to goal. The color indicators were the same as those reported by the blood pressure monitored when used at home. The pharmacist used the green (at goal), yellow (borderline), orange (stage I hypertension), and red (stage II hypertension) indicators as a springboard for discussion with the patient about causes of blood pressure variability. Through these targeted conversations about the home readings and diary entries, the pharmacist was able to identify patterns and hypertensive triggers.
The Results
Blood Pressure Outcomes
Evaluation
Outcomes were evaluated primarily by changes in participants’ blood pressure measurements, reported as the percentage of participants meeting blood pressure goal at baseline compared to at the end of follow-up.
Results were published in the winter of 2013. Read them here.