Physician-Pharmacist Comanagement of Hypertension: A Randomized, Comparative Trial

Authors

  • Dr. Jeff E. Borenstein M.D., M.P.H.,

    Corresponding author
    1. Departments of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, California
    2. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
    3. Cedars-Sinai Health System, Beverly Hills, California School of Medicine, University of California Los Angeles, Los Angeles, California
      Health Services Research Department, Cedars-Sinai Health System, 9100 Wilshire Boulevard, East Tower, Suite 655, Beverly Hills, CA 90212; e-mail: jeff.borenstein@cshs.org.
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  • Dr. Geneen Graber Pharm.D.,

    1. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Dr. Emmanuel Saltiel Pharm.D.,

    1. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
    2. Pharmacy, School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Dr. Joel Wallace Pharm.D.,

    1. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Dr. Seonyoung Ryu Pharm.D.,

    1. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Dr. Archi Jackson Pharm.D.,

    1. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Dr. Stephen Deutsch M.D.,

    1. Departments of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, California
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  • Dr. Scott R. Weingarten M.D., M.PH.

    1. Departments of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, California
    2. Health Services Research, School of Medicine, University of California Los Angeles, Los Angeles, California
    3. Cedars-Sinai Health System, Beverly Hills, California School of Medicine, University of California Los Angeles, Los Angeles, California
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Health Services Research Department, Cedars-Sinai Health System, 9100 Wilshire Boulevard, East Tower, Suite 655, Beverly Hills, CA 90212; e-mail: jeff.borenstein@cshs.org.

Abstract

Objective. To compare the effectiveness of an evidence-based, systematic approach to hypertension care involving comanagement of patients by primary care physicians and clinical pharmacists versus usual care in reducing blood pressure in patients with uncontrolled hypertension.

Methods. Patients in a staff model medical group with uncontrolled hypertension were randomized to either a usual care (UC) or a physician-pharmacist comanagement (PPCM) group. All physicians in the study received both group and individual education and participated in the development of an evidence-based hypertension treatment algorithm. Physicians were then given the names of their patients whose medical records documented elevated blood pressures (defined as systolic ≥ 140 mm Hg and/or diastolic ≥ 90 mm Hg for patients aged < 65 yrs, and systolic ≥ 160 mm Hg and/or diastolic ≥ 90 mm Hg for those aged ≥ 65 yrs). Patients randomized to the UC group were managed by primary care physicians alone. Those randomized to the PPCM group were comanaged by their primary care physician and a clinical pharmacist, who provided patient education, made treatment recommendations, and provided follow-up. Blood pressure measurements, antihypertensive drugs, and visit costs/patient were obtained from medical records.

Results. One hundred ninety-seven patients with uncontrolled hypertension participated in the study. Both PPCM and UC groups experienced significant reductions in blood pressure (systolic −22 and −11 mm Hg, respectively, p<0.01; diastolic −7 and −8 mm Hg, respectively, p<0.01). The reduction in systolic blood pressure was greater in the PPCM group after adjusting for differences in baseline blood pressure between the groups (p<0.01). More patients achieved blood pressure control in the PPCM than in the UC group (60% vs 43%, p=0.02). Average provider visit costs/patient were higher in the UC than the PPCM group ($195 vs $160, p=0.02).

Conclusions. An evidence-based, systematic approach using physician-pharmacist comanagement for patients with uncontrolled hypertension resulted in improved blood pressure control and reduced average visit costs/patient.

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