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CDC Chief Praises Pharmacists' Work on Hypertension

[December 15, 2016, AJHP News]

Kate Traynor

BETHESDA, MD 23 Nov 2016—A top federal health official in September praised the efforts made last year by clinical pharmacists at Reliant Medical Group to improve their patients' blood pressure control.

The medical group, which serves nearly a quarter of a million patients in central Massachusetts, was one of 18 top-performing organizations in the area of hypertension control that participated in the federal Million Hearts Initiative during 2015. All 18 top performers, or hypertension champions, met the goal of controlling hypertension in at least 70% of adult patients diagnosed with the condition.

Reliant's hypertension control rate for adults was 79.9% during the reporting period, according to the health system.

The Million Hearts Initiative was launched in 2012 with the goal of preventing 1 million heart attacks and strokes by 2017 through the use of proven strategies, including hypertension control.

Centers for Disease Control and Prevention Director Thomas Frieden, during a September 13 media briefing, said Reliant's formula for success included "involving pharmacists after patients were discharged to assist with managing complex [medication] regimens."

"Pharmacists have a very important role. They are trusted advisers," Frieden added.

At the time they contributed to the Million Hearts achievement, Reliant's pharmacists were operating out of pharmacies housed in the same buildings as the clinics.

"We were retail pharmacists and we were doing clinical work," explained Folasade Foose, a clinical pharmacist for the health system.

"Most [of] the interactions with the patients were done over the phone," she said. "We did have the opportunity in some cases, if the patients were already filling their prescriptions at our retail sites, . . . to talk with them face to face."

But now, Foose is one of four full-time clinical pharmacists at Reliant who are fully integrated into patient care teams, working face to face to improve their patients' health.

"We're there for any medication-related questions or concerns of the patients and also as support for the doctors," Foose said.

Foose said Reliant's entire staff pitched in for the Million Hearts Initiative during the 2015 campaign. She said the pharmacists whose work Frieden cited had focused on about 400 patients with diabetes and hypertension who weren't taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB).

"We did a thorough medication review and we looked over their charts, and then we made recommendations to their primary care physician if they should be on an ACE inhibitor or an ARB. At that point, if the physician agreed with the recommendation—and in most circumstances they did—we reached out to patients," she said.

That outreach included calling patients to explain the benefits of the therapy, describe potential adverse effects, ensure that patients could afford the medications, and provide counseling on lifestyle modifications.

Under the current team-based model of care, Reliant's pharmacists continue to focus mainly on patients with diabetes, hypertension, or both.

"But if a doctor feels that a patient would benefit from our services, we're always open to these ad hoc consultations," Foose said.

For the approximately 550 patients with hypertension, she said, "We are getting them in, taking that blood pressure. We are following them long term."

That means checking whether patients are having their prescriptions refilled, recommending dosage changes, and reviewing laboratory test results.

When appropriate, Foose said, a pharmacist adjusts the patient's drug regimen to help achieve hypertension control targets. Other interventions may include referring patients to a dietitian or nutritionist.

All of this is done in consultation with the patient's primary care provider (PCP), she said.

"We are enforcing the messages the PCP has given them already," Foose explained.

She said Reliant is capturing but hasn't yet reported outcomes data under the team-based model. And pharmacists aren't directly billing for patient encounters, though she said that could change if the profession is granted healthcare provider status under Medicare.

"But right now it's not something that we have the ability to do," she said.

Foose said she's excited to have had the opportunity to use her skills to do more than just dispense medications. But she said it's also important for pharmacists to recognize their ability to help patients solve problems related to affording their medications and getting prescriptions filled.

"Oftentimes when patients go to their primary care physician, they might be a little bit hesitant to admit that they're having issues paying for their medications or they're having other issues," she said. "We should focus on the health of the patient—the whole patient—as best we can. And sometimes that involves looking at copays and looking at affordability. . . . And if affording medications affects compliance, then it is something that we should be involved in."

 

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