Targeting hypertension by helping pharmacists deliver enhanced patient care
Patients with high blood pressure are benefiting from the expanded role played by pharmacists in Alberta, according to a new study from the University of Alberta's Faculty of Medicine & Dentistry.
The results of the Rural Alberta Clinical Trial in Optimizing Hypertension (RxACTION) were published in the July edition of the journal Circulation. In the study, researchers compared conventional treatment of hypertension to "enhanced" pharmacist care—in which pharmacists independently prescribe antihypertensive drugs and take a more active role in managing patients. They found that at six months, the enhanced care resulted in significantly larger reductions in both systolic and diastolic blood pressure compared with usual care.
Patients who received the enhanced care were also twice as likely to reach their recommended blood-pressure targets as those treated conventionally.
"In Canada about 25 per cent of the population has high blood pressure and about two-thirds of it is controlled. But that means that about one-third is uncontrolled," says Ross Tsuyuki, lead author of the study, professor of medicine at the Faculty of Medicine & Dentistry, and a member of Alberta Health Services Cardiovascular Health & Stroke Strategic Clinical Network. "With a condition like high blood pressure, the treatment is virtually all about drugs—which is a field of medicine that pharmacists excel in. This work shows there is a real opportunity to better utilize pharmacists in our health-care system."
Alberta is the first jurisdiction in Canada and only the second in the world where pharmacists can apply to prescribe medications independently for patients.
The RxACTION project included 248 patients from 23 communities—most of them in rural Alberta. Two-thirds of the patients received care from prescribing pharmacists, with the remaining patients getting the usual care. The intervention group's care consisted of pharmacist assessment of the patients' risks, a review of their medications and the prescribing of new drug therapy if necessary. The patients also had regular follow-up from their pharmacists over the course of six months.
Lonni Johnson, a pharmacist at Winter's Pharmacy South in Drayton Valley who participated in the study, says her patients have benefited.
"They absolutely love the care they are getting," says Johnson. "They are gaining control over their high blood pressure, they know what they're taking and why they're taking it, and they have a better understanding of what they can do in their lifestyle to make things better."
Bernie Frost, a patient of Johnson's, agreed to take part in the RxACTION study three years ago. He says he wouldn't go back to the care he received before.
"I get one-on-one attention and a lot more information now about the medications I'm on. Going to the doctor before, it could take a week and a half sometimes to get in to see him. So if I can drop in to the pharmacist instead to renew my prescription, it saves a lot of time."
Frost adds, "I'm not sure if my health has improved but my knowledge is definitely better."
With the success of RxACTION, Tsuyuki's team is now working to implement the higher level of care in pharmacies across the province. It is also in the midst of a larger study called RxEACH with Alberta Health Services and Alberta Health aimed at identifying Albertans at risk for vascular disease, then providing them with screening and management strategies through a pharmacist intervention.
Johnson, who is participating in the new study, says she is excited to play a greater role in managing her patients' health in the future.
"I think this is the way we need to go in pharmacy. It's amazing! I do not want to practise as I have in the past. I want to move forward and change, and to play an even greater role within our patient's health-care team."
