Pharmacists Can Enhance Hypertension Control Through Team-Based Approaches

Hypertension is prevalent in the United States and the increasing shortage of primary care physicians (PCPs) is complicating the issue. Team-based care (TBC) improves continuity of patient care and accessibility.

TBC models use collaborative approaches to patient care involving various health care professionals. Pharmacist involvement in TBC is recommended based on strong evidence of efficacy in improving hypertension control and treatment cost-effectiveness. However, challenges such as varying scopes of practice and lack of sustainable payment models limit widespread implementation across different settings, largely due to barriers to financial viability.

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Researchers from the Michigan Medicine Hypertension Pharmacists’ Program (MMHPP) worked with the CDC Division for Heart Disease and Stroke Prevention to assess integration of pharmacists into health care teams. The study results are published in the Journal of the American Pharmacists Association.

The retrospective observational study focused on evaluating improvements in the availability ofhypertension management services associated with pharmacist participation. The MMHPP uses a TBC model which reallocates some PCP responsibilities to pharmacists for patients with diagnosed hypertension. Their analysis examined the impact of the MMHPP in increasing the availability of hypertension management services and identified barriers to program longevity. They conducted qualitative interviews with health care team members to assess factors that contributed to the success of the program.

The study findings showed that patients who received care from pharmacists had fewer PCP visits and were more likely to be appropriately referred to services such as cardiology, nutrition, and social work. Pharmacists increased patient accessibility to outpatient hypertension management services which improved the availability of PCPs. Interviews with health care team members reinforced the program’s ability to enhance continuity of care.

The study identified limited reimbursement options for pharmacist-provided patient care services as the primary obstacle to program sustainability, which is a well-known challenge. Although the MMHPP established fee-for-service and value-based reimbursement agreements with some payers, the payment received for billable services was insufficient to cover per-patient program costs.

Involving pharmacists in TBC improves efficiency, patient care capacity, and satisfaction. The study authors suggest comparable models are viable and duplicable through organizational endorsement, available infrastructure, and financial support. The investigators recommend health systems look into implementing or expanding pharmacist-provided hypertension management programs, secure initial funding, and establish a sustainable financial model for ongoing costs.

Reference

Wilson CC, Therrien NL, MacLeod KE, Soloe C, et al. Enhancing availability of services to control hypertension through a team-based care approach that includes pharmacists. J Am Pharm Assoc. 2024;102055. doi:10.1016/j.japh.2024.102055