Collaborative Model May Have Payoff for Minorities

Susan London

March 24, 2015

An innovative model whereby pharmacists collaborate with primary care providers in delivering care to hypertensive patients may help lower blood pressure (BP) among racial/ethnic minorities, a cluster-randomized trial suggests.

Barry L. Carter, PharmD, from the College of Pharmacy, University of Iowa, Iowa City, and colleagues conducted the trial, known as Collaboration Among Pharmacists and Physicians to Improve Outcomes (CAPTION), in 32 primary care offices that had an on-site clinical pharmacist practicing in the office. They randomly assigned the practices to deliver usual care as a control, deliver 9 months of the intervention, or deliver 24 months of the intervention.

For the intervention, pharmacists reviewed patients' medical records and interviewed them about medications, BP control, and barriers, and then followed up by telephone and in face-to-face visits out to 8 months, created a care plan with guideline-based recommendations for the physician to adjust therapy, and communicated directly with the physician. Physicians could accept or reject the recommendations or modify the plan.

The 625 patients included in the trial had uncontrolled hypertension. Slightly more than half were from racial/ethnic minority groups, and half had diabetes or chronic kidney disease.

The proportion of patients achieving BP control at 9 months, the trial's primary outcome, was 43% in intervention offices and 34% in control offices, according to results reported in an article published online March 24 in Circulation: Cardiovascular Quality and Outcomes. In adjusted analyses, the difference was not statistically significant, although there was a trend in favor of the intervention.

In contrast, the adjusted differences in mean systolic and diastolic BP between the intervention and control groups, which was the secondary endpoint, were significantly different at −6.1 and −2.9 mm Hg, respectively.

Control rates and reductions in BP were similar for minority and nonminority patients at this point.

In contrast, benefit after 9 months differed by minority status. Among minorities, the odds of BP control were significantly greater in both intervention groups than in the control group at 18 and 24 months, whereas no significant benefit was seen among nonminorities at these points.

In addition, initial reductions in BP seen with the intervention persisted among minority patients over time, whereas they deteriorated among nonminority patients.

The intervention appeared safe. Rates of serious adverse events overall and related to the study did not differ significantly across groups.

"This is the first study to demonstrate that an intervention with pharmacists embedded within the medical office could achieve similar reductions in BP across racial groups and that the effect could be sustained," the investigators note. They speculate that intensification of BP medications explained why benefit persisted even after the intervention ended. "The long-term effect of the intervention was greater in minority subjects than nonminority subjects," they add.

"These findings suggest that an established team-based care model involving pharmacists can be adopted in a large number of offices to reduce racial disparities in BP control."

The authors have disclosed no relevant financial relationships.

Circ Cardiovasc Qual Outcomes. Published online March 24, 2015.

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