Pharmacist collaborative care program with supplementary prescribing authority for hypertensive patients in primary health care
DOI:
https://doi.org/10.1590/s2175-97902025e23454Keywords:
Hypertension, Patient care team, Drug utilizatioAbstract
To evaluate the clinical outcomes of supplementary prescribing by pharmacist in reducing blood pressure versus other models of care in patients who recently received medical diagnosis of hypertension. A 24-month pragmatic controlled trial was performed with 225 patients divided into three groups: control 1 (medical centered care), control 2 (pharmacist collaborative care without supplementary prescribing authority) and intervention (pharmacist collaborative care with supplementary prescribing authority). A comparison of values was performed at basal and after 24-months of follow up in each group and differences between groups. We applied the chi-square test, student's t-test for independent samples, one-way anova whenever appropriate. A p value < 0.05 was considered statistically significant. Significant reduction in sbp and dbp was verified in every groups; intervention group showed a significantly higher reduction in the mean blood pressure levels versus control 2 (δ vs. Control 2 group = -14.3 [ci95 % -12.6 to -15.9 mmhg] p = 0.006; δ vs. Control 1 group = -17.8 [ci95 % -13.8 to -19.8 mmhg] p < 0.001) and dbp (δ vs. Control 2 group = -8.9 [ci95 % -7.7 to -10.9 mmhg] p = 0.005; δ vs. Control 1 group = -9.8 [ci95 % -7.7 to -11.5 mmhg] p < 0.001). Intervention group also showed significantly higher reduction in ldl-cholesterol and total cholesterol, versus other groups. Pharmacist collaborative care with supplementary prescribing authority provided better results in the management of blood pressure, ldl-cholesterol and total cholesterol versus other models of care.
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Awdishu L, Singh RF, Saunders I, Yam FK, Hirsch JD, Lorentz S, et al. Advancing Pharmacist Collaborative Care within Academic Health Systems. Pharmacy (Basel). 2019;7(4):142. Published 2019 Oct 11. doi:10.3390/pharmacy7040142.
Centers for Disease Control and Prevention. Tailored pharmacy-based interventions to improve medication adherence. Accessed November 2021.
Conselho Federal de Farmácia (Brasil). Resolução nº586, de 29 de Agosto de 2013. Regula a prescrição farmacêutica e dá outras providências. Available at: http://www.cff.org.br/userfiles/file/noticias/Resolu%C3%A7%C3%A3o586_13.pdf. Accessed September 02, 2013.
Cooper H, Booth K, Fear S, Gill G. Chronic disease patient education: lessons from meta-analyses. Patient Educ Couns 2001;44(2):107-1.
Cowart K, Sando K. Pharmacist Impact on Treatment Intensification and Hemoglobin A(1C) in Patients With Type 2 Diabetes Mellitus at an Academic Health Center. J Pharm Pract. 2019;32(6):648–654.
Dixon DL, Baker WL, Bucley LF, Salgado TM, Tassell BWV, Carter BL. Effect of a Physician/Pharmacist Collaborative Care Model on Time in Target Range for Systolic Blood Pressure: Post Hoc Analysis of the CAPTION Trial. Hypertension. 2021; 78(4). doi:10.1161/HYPERTENSIONAHA.121.17873.
Dixon DL, Sisson EM, Parod ED, Van Tassell BW, Nadpara PA, Carl D, W Dow A. Pharmacist-physician collaborative care model and time to goal blood pressure in the uninsured population. J Clin Hypertens (Greenwich). 2018;20(1):88–95.
Faul F, Erdfelder E, Buchner A, Lang AG. G*Power Version 3.1.7 [computer software]. Uiversität Kiel. Germany. 2013.
Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115mm Hg, 1990-2015. JAMA. 2017; 317(2):165-82.
Hirsch JD, Steers N, Adler DS, Kuo GM, Morello CM, Lang M, et al. Primary care-based, pharmacist-physician collaborative medication-therapy management of hypertension: a randomized, pragmatic trial. Clin Ther. 2014;36(9):1244-54.
Hunt JS, Siemienczuk J, Pape G, Rozenfeld Y, Mackay J, LeBlanc BH, et al. A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. J Gen Intern Med. 2008;23(12):1966-72.
Lewinski AA, Jazowski SA, Goldstein KM, Whitney C, Bosworth HB, Zullig LL. Intensifying approaches to address clinical inertia among cardiovascular disease risk factors: A narrative review. Patient Educ Couns. 2022;105(12):3381-3388. doi:10.1016/j.pec.2022.08.005.
Moraes RM de, Santos MAB dos, Vieira FS, Almeida RT de. Public policy coverage and access to medicines in Brazil. Rev Saúde Pública [Internet]. 2022; 56:58. Available from: https://doi.org/10.11606/s1518-8787.2022056003898.
Omboni S, Tenti M, Coronetti C. Physician-pharmacist collaborative practice and telehealth may transform hypertension management. J Hum Hypertens. 2018. doi10.1038/s41371-018-0147-x.
Owczarek A, Marciniak DM, Jezior R, Karolewicz B. Assessment of the Prescribing Pharmacist's Role in Supporting Access to Prescription-Only Medicines-Metadata Analysis in Poland. Healthcare (Basel). 2023;11(24):3106. doi:10.3390/healthcare11243106.
República Federativa do Brasil (Brasil). Lei n. 8080, 19 de setembro de 1990a. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Available at: http://portal.in.gov.br/. Accessed June 14, 2015.
República Federativa do Brasil (Brasil). Lei n. 8142, de 28 de dezembro de 1990b. Dispõe sobre a participação da comunidade na gestão do Sistema Único de Saúde (SUS) e sobre as transferências intergovernamentais de recursos financeiros na área da saúde e dá outras providências. Available at: http://portal.in.gov.br/. Accessed June 14, 2015.
Santschi V, Chiolero A, Colosimo AL, Platt RW, Taffé P, Burnier M, et al. Improving blood pressure control through pharmacist interventions: a meta-analysis of randomized controlled trials. J Am Heart Assoc. 2014;3:e000718.
SAS. JMP® Clinical. Data analysis software [Computer program]. Available at: https://www.jmp.com/en_us/home.html. Accessed February 25, 2015.
Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, et al. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res. 2023;119(2):381-409. doi:10.1093/cvr/cvac130.
Schwarz T, Schmidt AE, Bobek J, Ladurner J. Barriers to accessing health care for people with chronic conditions: a qualitative interview study. BMC Health Serv Res. 2022; 22(1):1037. doi:10.1186/s12913-022-08426-z.
Shin D, Choi J, Lee HY. Suboptimal control status of young hypertensive population. Clin Hypertens. 2023 May 1;29(1):13. doi: 10.1186/s40885-023-00237-6. PMID: 37122032; PMCID: PMC10150511.
Sociedade Brasileira de Cardiologia/Sociedade Brasileira de Hipertensão/ Sociedade Brasileira de Nefrologia. VI Diretrizes Brasileiras de Hipertensão. Arq Bras Cardiol. 2010;95(1 supl.1):1-51 [in Portuguese].
Sociedade Brasileira de Diabetes. Diretrizes da SBD 2014 – 2015. São Paulo: SBD, 2014.
Stroebel RJ, Obeidat B, Lim L, Mitchell JD, Jasperson DB, Zimring C. The impact of clinic design on teamwork development in primary care. Health Care Manage Rev. 2021 Jul-Sep 01;46(3):257-264. doi: 10.1097/HMR.0000000000000259. Epub 2019 Aug 5. PMID: 31385829.
The Community Guide. Community Preventive Services Task Force. TFFRS – heart disease and stroke prevention: tailored pharmacy-based interventions to improve medication adherence. Accessed January 24, 2024.
Tsuyuki RT, Rosenthal M, Pearson GJ. A randomized trial of a community-based approach to dyslipidemia management: Pharmacist prescribing to achieve cholesterol targets (RxACT Study). Can Pharm J (Ott). 2016;149(5):283-92.
United Kingdom. Department of Health. Supplementary prescribing by nurses, pharmacists, chiropodists ⁄ podiatrists, physiotherapists and radiographers within the NHS in England: a guide for implementation. 2005. London: NHS, 2005.
Weeks G, George J, Maclure K, Stewart D. Non-medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database Syst Rev. 2016;11:CD011227.
Xavier HT, Izar MC, Faria Neto JR, Assad MH, Rocha VZ, Sposito AC, et al. V Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose. Arq Bras Cardiol. 2013; 101(4Supl1):1-22 [in Portuguese].
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