A University of Iowa research team determined a physician-pharmacist intervention to improve blood pressure control among a diverse group of patients was cost-effective.
The study, led by Dr. Linnea Polgreen, assistant professor of pharmacy practice and science, found the cost to increase the rate of hypertension control by 1 percentage point was approximately $22.00. Other University of Iowa investigators include Dr. Christopher Coffey, professor of biostatistics, and Dr. Elizabeth Chrischilles, professor of epidemiology. The research was published online November 2, in the journal Hypertension.
“Prior studies have demonstrated the cost-effectiveness of collaborative hypertension control programs, however, most previous studies were conducted in fairly heterogeneous populations that lacked a large number of minority and low-income populations,” said Dr. Coffey, who directs the Clinical Trials Statistical and Data Management Center, which served as the data coordinating center for the study. “This is one of the first studies to demonstrate that the benefits can be achieved across a very diverse population.”
In the study of 625 patients, 38 percent were black, 14 percent were Hispanic and 49 percent had an annual household income of less than $25,000.
Costs were assigned to medications, and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in blood pressure measurements and hypertension control rates.
Participants were from 32 medical offices in 15 states, and all had uncontrolled high blood pressure, defined as systolic pressure of 140 mm Hg or higher, or diastolic of 90 mm Hg or higher. Among those with diabetes or chronic kidney disease, blood pressure was considered high at or above 130 mm Hg systolic or 80 mm Hg diastolic. Patients were randomized to a pharmacist-physician intervention program for nine months or to a control group receiving usual care.
The intervention included a clinical pharmacist reviewing patients’ medical records, contacting them by phone and regular face-to-face visits. The pharmacist created a care plan and made recommendations to the physician to adjust medication. Pharmacists worked in the medical office and met face-to-face with physicians.
After nine months of the collaborative intervention, average systolic blood pressure was 6.1 mm Hg lower, average diastolic pressure was 2.9 mm Hg lower, and hypertension control rate was 43 percent, compared to 34 percent in the control group.
The full study is available at http://hyper.ahajournals.org/