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Purpose: To evaluate a care management program for Veterans with hypertension (HTN) provided by clinical pharmacists.
Methods: Using a retrospective case-control design, cases included all HTN patients referred to the care management program while controls included HTN patients who were not referred to the program during the same one-year period. Each case was matched to a maximum of three controls on: primary care physician, age±5 years, diagnoses of diabetes and kidney disease, baseline systolic blood pressure(SBP) ±10 mmHg, and number of unique BP medications. Primary outcomes were SBP and diastolic blood pressure(DBP) at 6-,9-, and 12-months follow-up from baseline. Multivariate regression models compared each BP endpoint between the cases and controls adjusting for age, co-morbidities, baseline BP and baseline number of BP medications. Similar logistic regression models evaluated national guideline-defined BP control.
Results: Three to one matching was achieved in 77.4%(418/540) of cases; 85%(460/540) of cases had at least one matched control. Cases and controls did not differ with respect to age, gender, or co-morbidity; baseline BP was higher (139.6/80.0 vs. 136.7/78.2 mmHg) and BP control lower (35% vs. 49%) in the cases compared to controls. Among cases(n=460), BP decreased from baseline by -5.3/-2.4, -7.7/-3.2, and -6.6/-3.0 mmHg at 6-,9-, and 12-months; BP decreased among controls(n=1264) by -2.0/-1.0, -1.9/-0.9, and -3.4/-1.6 mmHg at 6-,9-, and 12-months. Multivariate regression modeling results identified significantly lower SBP for the cases compared with controls at all time points; but for DBP, only the 9-month follow-up was significantly lower. BP control was better among cases than controls at 6-(56% vs. 55%;OR=1.8 CI:1.3-2.4; p<0.001) and 9-months(65% vs. 54%;OR=2.3 CI:1.7-3.0; p<0.001) but not at 12-months(57% vs. 60%;OR=1.3 CI:0.95-1.7; p=0.11).
Conclusion: Patients referred to the pharmacist hypertension care management program had a significant improvement in most BP outcomes. This program may be an effective method of improving BP control among Veterans.