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CARDIOLOGY

Pharmacist Intervention Program for Control of Hypertension

Manager, Department of Health Economics & Outcomes Research, Merck Frosst Canada Ltd., Kirkland, Québec, Canada

Jocelyne Moisan, PhD

Director, Population Health Research Unit, Québec University Hospital, Québec; Professor, Faculty of Pharmacy, Laval University, Québec

Jean-Pierre Grégoire, PhD

Director, Department of Health Economics & Outcomes Research, Merck Frosst Canada Ltd.; Researcher, Population Health Research Unit, Québec University Hospital; Professor, Faculty of Pharmacy, Laval University

Alain Milot, MD MSc FRCPC

Internist and Pharmacologist, Québec University Hospital; Professor, Faculty of Medicine, Laval University

Reprints: Isabelle Chabot PhD, Merck Frosst Canada Ltd., 16711 TransCanada Hwy., Kirkland H9H 3L1, Québec, Canada, FAX 514-428-8655, isabelle_chabot{at}merck.com

BACKGROUND: Pharmaceutical care programs have been shown to improve outcomes in hypertension. However, most programs required direct access to patient medical chart and patient consultation sessions by appointment.

OBJECTIVE: To follow the current practice of community pharmacy, exploring the effect of an intervention program on blood pressure (BP) and factors affecting BP.

METHODS: Treated hypertensive patients were enrolled in a 9-month controlled study involving 9 community pharmacies. The PRECEDE–PROCEED model was used as conceptual framework to identify factors affecting BP, to incorporate those factors in an intervention program, and to evaluate the impact of the program. A computerized decision-aid tool was used by pharmacists from 4 pharmacies to provide pharmaceutical care to subjects (n = 41); pharmacists from the 5 other pharmacies performed usual care (n = 59). As there was a statistically significant interaction due to family income in describing the impact of pharmacists' intervention on BP, population was stratified by family income in the analyses.

RESULTS: Compared with the control group, the pharmacy program resulted in significant systolic BP reduction (-7.8 vs. 0.5 mm Hg; p = 0.01) and an increase in the proportion of controlled patients only for those with high incomes. In the high-income group, the program also had a positive impact on physical activity, self-reported adherence, health concerns, and information transmitted. The low-income group did not appear to benefit from the program.

CONCLUSIONS: Pharmacist intervention can modify factors affecting adherence, improve adherence, and reduce BP levels in patients treated with antihypertensive agents. Impact of pharmacist intervention on BP differed according to patient income status.

Key Words: adherence, hypertension, pharmaceutical care, socioeconomic status

Published Online, July 10, 2003. www.theannals.com, DOI 10.1345/aph.1C267

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