Home' Australian Pharmacist : Australian Pharmacist June 2013 Contents 66 Australian Pharmacist June 2013 I ©Pharmaceutical Society of Australia Ltd.
Pharmacist-physician collaboration to
optimise blood pressure control during
Background: International studies have demonstrated that blood pressure control in
community settings can be improved when pharmacists collaborate with physicians in
hypertension management. To date, no study has investigated the impact of this collaborative
model in a hospital setting.
Aim: To determine if a pharmacist-physician collaborative model can achieve better
BP control in a hospital setting.
Method: This non-randomised intervention study evaluated consecutive subjects with a
history of hypertension admitted to a specialist rehabilitation hospital. The study collected
demographic and BP related data on a retrospectively identified 'physician-alone managed
hypertension model' (pre-intervention arm). Rehabilitation physicians were then educated on
the National Heart Foundation (NHF) Hypertension Guidelines, before prospective data was
collected representing a 'pharmacist-physician collaborative model' (intervention arm) where
the pharmacist actively collaborated with the physicians in hypertension management by
recommending changes to anti-hypertensive therapy based on NHF Hypertension Guidelines.
Results: Anti-hypertensive therapy was altered to a greater extent post-intervention
(p<0.001), reflecting a change in prescribing practices of the rehabilitation physicians.
This resulted in a mean systolic blood pressure reduction of 9.1 mmHg in the intervention
group compared to 3.6 mmHg in the pre-intervention group (p=0.106). Allowing for
baseline differences, subjects' systolic blood pressure control had a significantly greater
likelihood to move towards attainment of target level in the intervention group
(p=0.013), with 20.8% patients reaching target systolic blood pressure compared to
10.5% pre-intervention group (p=0.143).
Conclusion: The pharmacist-physician collaborative model improved the prescribing
habits of the rehabilitation physicians in the management of hypertension and produced a
significant movement in subject's blood pressure control towards target levels at discharge
from hospital. Larger studies with longer follow-up periods extending into community
settings are needed to confirm these results.
In Australia, clinical pharmacists
collaborate closely with physicians
in patient management; however to
our knowledge no Australian study
has investigated the impact of this
collaborative work in chronic disease,
let alone in hypertension management.
This study sought to investigate the impact
of pharmacist-physician collaboration
in hypertension management in a
Hypertension is a major independent
risk factor for the early development
of coronary artery disease, renal failure
and stroke.1 The risk of cardiovascular
disease increases with increased blood
pressure (BP) throughout a wide range.2
The reduction of a few millimeters of
mercury (mmHg) across a population's
systolic blood pressure (SBP) would result
in major benefits in preventing stroke
and ischaemic heart disease.2 High blood
pressure affects one in four Australians and
50% do not have blood pressure managed
to target levels.3 Studies have shown
that target SBP can be best achieved if a
protocol is followed and individuals are
treated with rational combinations of two
to three drugs.4--6
International studies in community settings
have shown that pharmacist involvement
Radhika Somasundaram, Senior Clinical
Pharmacist, Blacktown Hospital, NSW.
A/Prof Ian Baguley, Rehabilitation
physician, Westmead Rehabilitation
Hospital, NSW and The Western Medical
School, University of Sydney.
Dr Johnson George, Senior Lecturer,
Centre for Medicine Use and Safety,
Faculty of Pharmacy and Pharmaceutical
Sciences, Monash University, Victoria.
Kirstie Galbraith, Director, Postgraduate
Studies and Professional Development
Unit, Faculty of Pharmacy and
Pharmaceutical Sciences, Monash
Dr Melissa Nott, Westmead Brain Injury
Unit, Westmead, NSW.
in hypertension management improved
guideline adherence, BP control and the
number of people attaining BP targets
compared to hypertension managed by
a physician alone.7--9 Guideline adherence
improved by 12% in the collaborative
model compared to 4% in the physician
alone model, and resulted in better BP
control in the collaborative model (63.9%
vs. 29.9%; p<0.001).9
It is increasingly recognised that the care of
an ageing population with multiple chronic
illnesses should involve co-ordination
of care between physicians and
non-physician health care professionals.10
However, the evidence for the benefits
of pharmacist-physician collaboration is
limited in many areas of care. Against this
background, the present study sought
to investigate the impact and efficacy of
pharmacist-physician collaboration in the
inpatient management of hypertension.
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