Pe. Bogden et al., COMPARING STANDARD CARE WITH A PHYSICIAN AND PHARMACIST TEAM-APPROACHFOR UNCONTROLLED HYPERTENSION, Journal of general internal medicine, 13(11), 1998, pp. 740-745
OBJECTIVE: To assess the effect of a physician and pharmacist teamwork
approach to uncontrolled hypertension in a medical resident teaching
clinic, for patients who failed to meet the recommended goals of the f
ifth Joint National Commission on Detection, Evaluation and Treatment
of High Blood Pressure. HYPOTHESIS: Physician and pharmacist teamwork
can improve the rate of meeting national blood pressure goals in patie
nts with previously uncontrolled hypertension. DESIGN:A single-blinded
randomized controlled trial lasting 6 months. SETTING: A primary care
outpatient teaching clinic. PATIENTS:A sample of 95 adult hypertensiv
e patients who failed to meet national blood pressure goals based on t
hree consecutive visits over a 8-month period. INTERVENTION Patients w
ere randomly assigned to a control arm of standard medical care or to
an intervention arm in which a physician and pharmacist worked togethe
r as a team. MAIN RESULTS:At study completion, the percentage of patie
nts achieving national goals due to intervention was more than double
the percentage in the control arm (55% vs 20%, p < .001). Systolic blo
od pressure declined 23 mm Hg in the intervention arm versus 11 mm Hg
in the control arm (p < .01). Diastolic blood pressure declined 14 and
3 mm Hg in the intervention and control arms, respectively (p < .001)
. The intervention worked equally as well in men and women and demonst
rated noticeable promise in a minority of mixed-ancestry Hawaiians in
whom hypertension is of special concern. .. CONCLUSIONS: Patients who
fail to achieve national blood pressure goals under standard outpatien
t medical care may benefit from a program that includes a physician an
d pharmacist teamwork approach.