Hypertension Management Program: Year 1 Success Story
Overview
The Hypertension Management Program (HMP) began as a collaboration between the South Dakota Department of Health (SD DOH) and the Community Pharmacy Enhanced Services Network of South Dakota (CPESN SD). The SD DOH/CPESN SD HMP is a community pharmacy delivered hypertension management program. The goals of the program are to improve patient care access and understanding of their hypertension condition, increase public awareness of uncontrolled hypertension, boost self-monitored blood pressure measurement in South Dakota residents, and improve patients’ quality of life. Finally, an overall goal is to utilize frequent patient communication and close patient relationships with South Dakota community pharmacies to increase collaboration between non-physician health care providers and primary care providers to improve cardiovascular outcomes for South Dakota residents.
Through a pharmacy-based identification process, candidates with uncontrolled hypertension were eligible to enroll for the HMP at six community pharmacies (Bien Pharmacy, Brother’s Pharmacy, Haisch Pharmacy, Roger’s Pharmacy, Shane’s Pharmacy, and The Medicine Shoppe Pharmacy) across South Dakota. Patients were considered to have uncontrolled hypertension if they presented to the pharmacy with a new hypertension diagnosis, a new anti-hypertensive medication, or an in-pharmacy blood pressure reading above goal. Patients underwent a 90-minute in-person hypertension counseling session with their pharmacist, including details about the patient’s condition, medication therapy, lifestyle factors, and proper home blood pressure monitoring techniques. Patients were then trained on blood pressure machines they were able to take home. Pharmacy team members checked in twice monthly with the patient to monitor home blood pressure readings and assess movement toward the patient’s blood pressure goal. Pharmacists worked directly with physicians, other health care providers, and the patient to ensure their medication therapies were working.
Current Program
Year 2 (June 1, 2020-May 31, 2021) of the program continues to increase collaboration between non-physician health care providers and primary care providers by focusing on physician-identified patients with uncontrolled hypertension. Community pharmacists reached out to local physicians to inform them about the HMP at the beginning of Year 2. Physicians referred patients to the community pharmacy-based HMP based on clinical discretion. Patients decided if they wished to participate in this program, however interest in attending inperson HMP sessions was reduced during the COVID 19 pandemic. Therefore, the number of participants was slightly lower for Year 2 when compared to Year 1 (47 vs. 57 respectively). Despite difficulties presented by the pandemic, preliminary results for Year 2 appear promising.
Results
Of the 57 enrolled patients in Year 1 (July 1, 2019- May 31, 2020) of the Hypertension Management Program, 54 completed the 8-month program, with 49 participants achieving their American Heart Association recommended blood pressure goal. Pharmacies completed 1,110 care calls with patients and 47 clinical interventions with other health care professionals. The average time it took for a patient to remain stable at their blood pressure goal for four weeks was 22 weeks. Average patient systolic blood pressures were reduced by 15% and diastolic blood pressures were reduced by 13%.
What do patients say?
“I think this program is really a great thing. It seems like there is so much time between appointments with my physician. This gives me a way to stay on top of monitoring my blood pressure between appointments and it is nice to know someone is looking at them regularly.”
“The blood pressure monitoring program from my pharmacy was a miracle. I struggled with high blood pressure for years. I didn’t understand why and I was dangerously high. After I visited with my pharmacist at the store, I began understanding that many of the things I was doing in my life were not good for me. It helped me to get my blood pressure to a goal that my doctor is happy with. I just did not know how dangerous my high blood pressure was. Thanks to my pharmacist working with my doctor, I know I will be enjoying the later years of my life with less concern about stroke.”
What do participating pharmacists say?
“We have a young participant who was identified through a hypertension screening. This participant is a smoker who would like to quit but had been struggling to do so. She did not realize the impact smoking was having on her blood pressure. It was through talking to her that I had my AHA moment …I realized for this individual I could use this program not only to help her control hypertension, but also to help her quit smoking (even further reducing her risk of heart attack and stroke) by using the blood pressure monitor as a tool. While it is obvious that smoking increases blood pressure it can be hard to “show” this to a patient. By monitoring her blood pressures on a daily basis and at different times of the day she could easily see the impact of smoking or not smoking on her blood pressures. This blood pressure program really allowed us to provide this participant with even more than just hypertension management.”
“This program has finally allowed me to take care of my patients with hypertension in a way that makes sense for them…. to meet them at their level and explain how hypertension can affect every major organ system in the body. Our patients are so appreciative of the information…. the reduction in blood pressure values we have seen among participants is inspiring.”
Future Directions
In addition to hypertension monitoring, Year 3 of the SD DOH/CPESN SD collaboration will begin in the summer of 2021 and will focus on reducing patients’ overall cardiovascular risk through the implementation of a cholesterol management program in addition to the hypertension management program.
