Hypertension-focused Medication Therapy Management

A Collaborative Pilot Program Uniting Pharmacists, Public Health, and Health Insurers in Wisconsin

Hailey Thompson, BS; Lena Swander, MPH; Rebecca Cohen, MS; Alan Lukazewski, RPh; Tim Bartholow, MD; Mary Pesik, RDN, CD; Kari Trapskin, PharmD

Disclosures

Prev Chronic Dis. 2020;17(9):e105 

In This Article

Abstract and Introduction

Abstract

Heart disease and stroke are leading causes of death and disability in the United States, and high blood pressure is a major risk factor for both. Community pharmacists are readily positioned to improve cardiovascular health through services such as medication therapy management and self-management education. In 2018, the Pharmacy Society of Wisconsin, the Wisconsin Division of Public Health, and NeuGen, a not-for-profit health insurer, piloted a pharmacist-led medication therapy management program for people with hypertension in partnership with 8 community pharmacies. We evaluated changes in use of blood pressure self-management tools and barriers to antihypertensive medication adherence before and after medication therapy management services. Participant satisfaction was also assessed for the 59 participants at the end of the program. We observed improvements in self-reported use of self-management tools, reductions in medication adherence barriers, and high satisfaction with pharmacist care. This collaborative pilot resulted in sustainable reimbursement for participating pharmacies delivering medication therapy management services to eligible NeuGen members.

Introduction

Heart disease and stroke are leading causes of death and disability in the United States, and high blood pressure is a major risk factor for both.[1] The Centers for Disease Control and Prevention recommends pharmacist-delivered medication therapy management (MTM) services to improve cardiovascular health for those with hypertension.[2] MTM is an umbrella term for medication services that include, but are not limited to, comprehensive medication review/assessment (CMR/A), the creation of medication-related action plans, pharmacist referral or intervention, and documentation and follow-up.[3] Evidence suggests that pharmacist-led interventions with elements of MTM delivered in a community pharmacy setting are effective in helping patients with hypertension lower their blood pressure and even achieve control. A 2014 systematic review and meta-analysis of randomized controlled trials associated community pharmacist-led interventions with significant reductions in systolic and diastolic blood pressure compared with usual care.[4] Interventions included pharmacological components (eg, identifying adverse drug effects and prescribing issues), nonpharmacological components (eg, providing education on healthy lifestyle changes), or both. Early evidence also suggests that when pharmacists are engaged in education about self-measured blood pressure monitoring, patients with hypertension achieve better blood pressure outcomes.[5–7]

In 2017, the Association of State and Territorial Health Officials (ASTHO) announced a year-long learning collaborative with the state public health agency focused on improving population-level blood pressure control.[8] The ASTHO learning collaborative required that state public health agencies partner with private health insurers to improve cardiovascular outcomes in an innovative manner. The collaborative's design allowed Wisconsin's grant recipients to contribute to evidence surrounding pharmacist-delivered MTM and its impact on cardiovascular health.

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