Hypertension
Olivia Welter, PharmD
A CDC evaluation found that 66% of participants in a pharmacist-led hypertension program—the University of Michigan Health Hypertension Pharmacists’ Program—achieved blood pressure control within 3 months of starting the program, compared to only 42% of non-participants.
The program, created in 2009 by Hae Mi Choe, PharmD, included embedded pharmacists within each of the University of Michigan Health’s primary care clinics. Today, the program involves all 14 University of Michigan Health clinics as well as 4 Meijer pharmacies and even serves as the basis for CDC’s latest implementation guide—published in June 2021—on the pharmacists’ patient care process.
The University of Michigan Health Hypertension Pharmacists’ Program also embodies the spirit of the 2020 Surgeon General’s Call to Action to Control Hypertension. In one section of the call to action, which discussed strategies for controlling hypertension, pharmacist-
based interventions were specifically identified as a potential solution to the issue at hand.
Pharmacists improve hypertension in the U.S.
Hypertension is an ever-prevalent medical condition in the United States. In fact, close to half the adults in the country have high blood pressure, and only 25% of those individuals have their blood pressure under control.
As some of the most accessible health care professionals, pharmacists have a heightened ability to positively impact blood pressure control.
Several studies have shown that close interaction with a pharmacist and frequent follow-up improves patient adherence to cardiovascular medications, with one study indicating that approximately 7% more patients are consistently adherent to taking their prescription medication when a pharmacist is routinely involved in their care compared to their primary care provider alone. Being available in the community setting, outside of normal business and clinic hours, is one of the contributing factors to the success of pharmacist involvement in chronic hypertension management.
Components of a successful program
According to Choe, associate chief officer for quality and care innovation with the University of Michigan Medical Group, there are several components that are necessary for clinicians to consider when starting a program such as the Hypertension Pharmacists’ Program. She said the first step is to create and establish trusting professional relationships with physicians, nurses, administrators, and any other members of the care team who are essential to hypertension care. Having these relationships instills more confidence in care team members that pharmacists can control a patients’ blood pressure. It also demonstrates to the patients that their primary care providers trust the pharmacist to manage their hypertension.
Another consideration is the referral mechanism of patients to pharmacists. Within the Hypertension Pharmacists’ Program, there is an automatic system for referrals in which, if blood pressure is elevated to a certain value in 2 separate readings during a primary care provider visit, the patient is automatically prompted to schedule an appointment with a pharmacist as they are checking out. This important system creates connections to the pharmacist that would have not been made otherwise.
Finally, establishing tight follow-up schedules is one of the most important components of the program, according to Choe. “Clinical inertia is one of the biggest barriers to patient care,” she said. In this case, clinical inertia means the failure to establish appropriate targets to meet treatment goals. Essentially, the follow-up gets lost as high blood pressure readings may be attributed to stress or a cup of coffee.
Within the program, patients have visits every 2 to 4 weeks with a pharmacist until their blood pressure goal is achieved, and they are then returned to only regular appointments with their primary care provider.
Choe’s advice for pharmacy teams looking to implement a similar program? “Start somewhere,” she said. Choe noted that a small step is better than no step at all, and that small step can lead to lasting clinical change for many patients.