Home and Community Care Digest
Methods: A one-year randomized controlled trial was conducted at 10 medical centers within Group Health, a nonprofit integrated group practice that provides medical insurance and care to residents in Washington State and Idaho. Approximately 260 patients were randomly assigned to one of three groups: 1) usual care, 2) web training for on-line patient medical services (e.g., prescription refills, make appointments, view parts of the electronic medical record, and use secure messaging to contact health care team members) and home blood pressure monitoring, and 3) same as the second group with the addition of pharmacist care delivered through Web communication. Patients were eligible for participation if they had uncontrolled hypertension, were taking antihypertensive medications, not diagnosed with diabetes, renal disease or other cardiovascular disease, and knew how to use a computer , be reached by telephone and had internet access. After taking the medical history, the pharmacist introduced the patient to his or her individualized action plan, which consisted of instructions for home blood pressure monitoring, a list of medication currently taking, one or more patient-selected lifestyle goals, recommended medication changes, and a follow-up plan. Communication with the pharmacist occurred every two weeks until blood pressure was controlled and then less often until the end of the study.
Findings: The addition of Web-based pharmacist care to home blood pressure monitoring and Web training resulted in 25% and 20% more patients with controlled blood pressure compared to the usual care group and the home blood pressure monitoring and Web training only group, respectively. That is, an addition of Webbased pharmacist care management to home blood pressure (BP) monitoring and Web training resulted in a 1.8 times increase in BP control as compared to the usual care group. Additionally, patient receiving Webbased pharmacists also had an increase in the mean number of antihypertensive medication classes filled of 2.16 (0.93), which was significantly higher than those in the usual care group (p<.001) and the home BP monitoring and Web training only group (p<.01). Moreover, the addition of on-line pharmacist care was also particularly beneficial to patients with the highest systolic blood pressure at baseline, which is generally difficult to treat and associated with increased cardiovascular risk.
Conclusions: The addition of pharmacist care management to home BP monitoring and secure patient Web Site training led to improved BP control in patients with hypertension. However, the electronic medical record, Web-based medical services, and clinical pharmacist care were already part of Group Health's medical centers. Other medical centers might experience difficulty trying to integrate these varied services and provide similar care to their patients. Additionally, in an era of rapidly increasing health care expenditures, one needs to closely examine the costs associated with adding an extra 2-8 hours of work for the pharmacist. This study highlights the positive impact of a pharmacist on hypertensive patient health outcomes, which can be used as additional evidence for expanding the role of pharmacists.
Green, BB, Cook, AJ, Ralston, JD, et al. Effectiveness of home blood pressure monitoring, web communication, and pharmacist care on hypertension control: A randomized controlled trial. JAMA. 2008; 299(24): 2857 - 2867.
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