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Special Feature
Evaluation of a hypertension medication therapy management program in patients with diabetes
Lourdes G. Planas, PhD; Kimberly M. Crosby, PharmD, BCPS, CGP; Kimberly D. Mitchell, PharmD; Kevin C. Farmer, PhD
J Am Pharm Assoc. 2009;49:164-170. doi:10.1331/JAPhA.2009.08164

Abstract

Objective  To evaluate the effect of a 9-month community pharmacy–based medication therapy management (MTM) program on quality of care in patients with diabetes and hypertension.

Design  Randomized controlled trial.

Setting  Tulsa, OK, between November 2005 and July 2007.

Patients  52 patients with diabetes and hypertension who were enrolled in a managed care organization.

Intervention  During monthly visits, intervention group participants received MTM services for hypertension and diabetes management.

Main outcome measures  Systolic blood pressure (SBP), percentage at goal blood pressure (<130/80 mm Hg), and antihypertensive medication adherence.

Results  The mean intervention group SBP decreased 17.32 mm Hg, whereas the mean control group SBP level increased 2.73 mm Hg (P = 0.003). The percentage of patients at goal blood pressure increased from 16.0% to 48.0% in the intervention group and decreased from 20.0% to 6.67% in the control group. Intervention group participants were 12.92 times more likely than control group participants to achieve goal blood pressure (P = 0.021). Although the mean adherence rate in the intervention group increased 7.0% while remaining fairly constant in the control group (−0.7%), this group difference was not statistically significant.

Conclusion  A community pharmacy–based hypertension MTM program was effective in improving blood pressure control among managed care enrollees with diabetes and hypertension. Community pharmacists are strategically positioned to provide MTM services and effectively communicate with providers to improve quality of care for patients.

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References

Ong KL, Cheung BMY, Man YBet al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999-2004. Hypertension. 2007;49:69–75.[PubMed][CrossRef]
 
Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.[PubMed]
 
Parving HH. Controlling hypertension in diabetes. Acta Diabetol. 2002;39(suppl 2):S35–40.[PubMed]
 
 Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA:  U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
 
 American Diabetes Association. Standards of medical care in diabetes–2008. Diabetes Care. 2008;31(suppl 1):S12–54.[PubMed]
 
Ong KL, Cheung BMY, Wong LYF, et al. Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999-2004. Ann Epidemiol. 2008;18:222–9.[PubMed]
 
Stratton IM, Adler AI, Neil HAW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405–12.[PubMed]
 
Adler AI, Stratton IM, Neil HAW, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321:412–9.[PubMed]
 
Park JJ, Kelly P, Carter BL, Burgess PP. Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc. 1996;NS36:443–51.
 
Carter BL, Barnette DJ, Chrischilles E, et al. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy. 1997;17:1274–85.[PubMed]
 
Erickson SR, Slaughter R, Halapy H. Pharmacists’ ability to influence outcomes of hypertension therapy. Pharmacotherapy. 1997;17:140–7.[PubMed]
 
Chabot I, Moisan J, Gregoire JP, Milot A. Pharmacist intervention program for control of hypertension. Ann Pharmacother. 2003;37:1186–93.[PubMed]
 
Bunting BA, Smith BH, Sutherland SE. The Asheville Project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc. 2008;48:23–31.
 
Cramer JA, Benedict A, Muszbek N, et al. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62:76–87.[PubMed]
 
DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–9.[PubMed]
 
Ho PM, Magid DJ, Shetterly SM, et al. Importance of therapy intensification and medication nonadherence for blood pressure control in patients with coronary disease. Arch Intern Med. 2008;168:271–6.[PubMed]
 
 American Diabetes Association. Clinical practice recommendations 2005. Diabetes Care. 2005;28(suppl 1):S1–79.[PubMed]
 
Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50:105–16.[PubMed]
 
Coast-Senior EA, Kroner BA, Kelley CL, Trilli LE. Management of patients with type 2 diabetes by pharmacists in primary care clinics. Ann Pharmacother. 1998;32:636–41.[PubMed]
 
Gerber RA, Liu G, McCombs JS. Impact of pharmacist consultations provided to patients with diabetes on healthcare costs in a health maintenance organization. Am J Manag Care. 1998;4:991–1000.[PubMed]
 
Berringer R, Shibley MC, Cary CC, et al. Outcomes of a community pharmacy-based diabetes monitoring program. J Am Pharm Assoc. 1999;39:791–7.
 
Nau DP, Ponte CD. Effects of a community pharmacist-based diabetes patient-management program on intermediate clinical outcome measures. J Manag Care Pharm. 2002;8:48–53.
 
Cranor CW, Christensen DB. The Asheville Project: short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:149–59.
 
Cranor CW, Bunting BA, Christensen DB. The Asheville Project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2003;43:173–84.
 
Irons BK, Lenz RJ, Anderson SL, et al. A retrospective cohort analysis of the clinical effectiveness of a physician-pharmacist collaborative drug therapy management diabetes clinic. Pharmacotherapy. 2002;22:1294–300.[PubMed]
 
Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998;351:1755–62.[PubMed]
 
Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–53.[PubMed]
 
 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.[PubMed]
 
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