Doctor-Pharmacist Teams Boost Blood Pressure Control
MONDAY Nov. 23, 2009 -- High blood pressure is better controlled by doctor-pharmacist teams working hand-in-hand than by doctors and pharmacists working alone, a new study shows.
"When physicians work with pharmacists, medications are intensified, dosages increased, medications used more effectively," said Barry L. Carter, a professor in the University of Iowa College of Pharmacy and lead author of a report in the Nov. 23 issue of the Archives of Internal Medicine. "Medication compliance is lesser reason for the improvement."
The journal report describes a study in which 402 people treated for high blood pressure at six clinics were divided into two groups. One group got the usual high blood pressure treatment, in which a prescription is written based on the doctor's measurement of blood pressure, and a pharmacist simply fills the prescription.
The other group was treated by doctor-pharmacist teams in which the pharmacists were trained to assess participants' blood pressure and adjust both the kind of drugs prescribed and the dosage of those drugs.
After six months, blood pressure had dropped to the recommended level in 30 percent of the participants in the traditional treatment group, while 64 percent of those treated by a pharmacist-physician team achieved the goal.
Is such a team approach possible in ordinary medical practice? Carter said it's already being done in some special settings -- by managed care organizations such as Kaiser Permanente, Veterans Affairs, and a number of academic health centers.
"A minority of patients now have access to such care, but that could change as the health-care system changes," he said.
But he said it's also possible in the usual setting of medical care, in which one doctor is responsible for an individual's care, Carter said. "There can be collaborative efforts that would be very effective with working partners," he said. Several states, including Iowa, have programs supporting the establishment of such working partnerships, he said.
A partnership approach can clearly improve efforts to control high blood pressure, which is a major risk factor for heart attack, stroke and other cardiovascular problems, Carter said.
"Medication compliance accounts for only 15 to 20 percent of blood pressure control problems," he said. "Most of the time, medications are not used in the right doses and right combinations to get the job done."
And what works for blood pressure control could be applied to other chronic medical problems, Carter said. "There have been positive studies in diabetes, high cholesterol and asthma, among others," he said.
Helene Levens Lipton, a professor of health policy at the University of California, San Francisco, said that doctor-pharmacist partnerships are becoming more important as the population of aging Americans increases.
"We're facing a major crisis in the form of a primary care physician shortage, so we need to look at new models," said Lipton, who wrote an accompanying editorial.
Though the concept is not new, "lots of physicians now are looking to allied health professionals to perform activities they just don't have time to do," she said. "A physician would really like to have a pharmacist there to help, showing how to save money on high blood pressure medication and making sure you are complying with the medications that are prescribed."
But partnership arrangements "are not going to happen without some kind of incentive," Lipton said. The most obvious incentive, she said, would be higher Medicare and Medicaid payments for medical professionals who set up such partnerships.
The U.S. National Heart, Lung and Blood Institute offers a guide to blood pressure control.
Posted: November 2009