ORIGINAL
PAPER
Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans Barry L. Carter, Pharm D;1,2,3 Mark W. Vander Weg, PhD;2,4,5 Christopher P. Parker, Pharm D;1 Cassie C. Goedken, MPH;2 Kelly K. Richardson, PhD;2 Gary E. Rosenthal, MD2,4,6 From the Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA;1 Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA;2 Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA;3 Department of Internal Medicine, Division of General Internal Medicine, Carver College of Medicine, Iowa City, IA;4 Department of Psychology, University of Iowa, Iowa City, IA;5 and University of Iowa Institute for Clinical and Translational Science, Iowa City, IA6
Clinical pharmacists are utilized in Veterans Health Administration (VHA) facilities to assist with management of patients with chronic conditions including hypertension. The goal of this study was to examine blood pressure (BP) control after discontinuation of an intensive pharmacistmanaged intervention. The study was conducted at a single Midwest VHA medical center and two affiliated communitybased outpatient clinics. Patients with uncontrolled BP received an intensive pharmacist intervention for the first 6 months. Patients were then stratified based on whether their BP was controlled or not and were randomized to either continue the intervention for another 24 months (30 month total time period) or the intervention was discontinued following one-time receipt of educational materials. Mean systolic and diastolic BPs were reduced (P200 mm Hg or diastolic BP [DBP] >114 mm Hg); (3) history of acute myocardial infarction, stroke, or unstable angina in the prior 6 months; (4) heart failure caused by systolic dysfunction with a left ventricular ejection fraction 2 times control or total bilirubin >1.5 mg/dL) in the prior 6 months; (7) pregnancy; (8) prior diagnoses of pulmonary hypertension or sleep apnea (unless treated by continuous positive pressure ventilation); (9) poor prognosis, with a life expectancy estimated less than 2 years; (10) residence in a nursing home or diagnosis of dementia; (11) inability to give informed consent or impaired cognitive function (as defined above); and (12) no telephone for follow-up calls. Study personnel were trained to measure BP using standardized guidelines.11,12 BP was measured three times using an automated device (HEM 907-XL; Omron, Schaumburg, IL). The second and third BP values at each study visit were averaged using previous methods to determine the research BP value.11,13 Research BP measurements were obtained at baseline and at 6, 12, 18, 24, and 30 months in all patients. At the baseline visit, study personnel reviewed the study with the patient and obtained informed consent. If the patient’s BP did not meet the inclusion criteria or if their SBP was >200 mg Hg or 114 mg Hg or
PAPER
Sustained Blood Pressure Control Following Discontinuation of a Pharmacist Intervention for Veterans Barry L. Carter, Pharm D;1,2,3 Mark W. Vander Weg, PhD;2,4,5 Christopher P. Parker, Pharm D;1 Cassie C. Goedken, MPH;2 Kelly K. Richardson, PhD;2 Gary E. Rosenthal, MD2,4,6 From the Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, IA;1 Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA;2 Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA;3 Department of Internal Medicine, Division of General Internal Medicine, Carver College of Medicine, Iowa City, IA;4 Department of Psychology, University of Iowa, Iowa City, IA;5 and University of Iowa Institute for Clinical and Translational Science, Iowa City, IA6
Clinical pharmacists are utilized in Veterans Health Administration (VHA) facilities to assist with management of patients with chronic conditions including hypertension. The goal of this study was to examine blood pressure (BP) control after discontinuation of an intensive pharmacistmanaged intervention. The study was conducted at a single Midwest VHA medical center and two affiliated communitybased outpatient clinics. Patients with uncontrolled BP received an intensive pharmacist intervention for the first 6 months. Patients were then stratified based on whether their BP was controlled or not and were randomized to either continue the intervention for another 24 months (30 month total time period) or the intervention was discontinued following one-time receipt of educational materials. Mean systolic and diastolic BPs were reduced (P200 mm Hg or diastolic BP [DBP] >114 mm Hg); (3) history of acute myocardial infarction, stroke, or unstable angina in the prior 6 months; (4) heart failure caused by systolic dysfunction with a left ventricular ejection fraction 2 times control or total bilirubin >1.5 mg/dL) in the prior 6 months; (7) pregnancy; (8) prior diagnoses of pulmonary hypertension or sleep apnea (unless treated by continuous positive pressure ventilation); (9) poor prognosis, with a life expectancy estimated less than 2 years; (10) residence in a nursing home or diagnosis of dementia; (11) inability to give informed consent or impaired cognitive function (as defined above); and (12) no telephone for follow-up calls. Study personnel were trained to measure BP using standardized guidelines.11,12 BP was measured three times using an automated device (HEM 907-XL; Omron, Schaumburg, IL). The second and third BP values at each study visit were averaged using previous methods to determine the research BP value.11,13 Research BP measurements were obtained at baseline and at 6, 12, 18, 24, and 30 months in all patients. At the baseline visit, study personnel reviewed the study with the patient and obtained informed consent. If the patient’s BP did not meet the inclusion criteria or if their SBP was >200 mg Hg or 114 mg Hg or
