(1177) Pharmacist Intervention Impacting the Use of Evidence-based Hypertension Therapy

Objectives: A method that has been shown to improve clinical outcomes in the outpatient setting is the use of an interprofessional approach through physician referrals to pharmacists in combination with telehealth and remote monitoring. The inclusion of pharmacists in therapy management has been seen as beneficial as pharmacists are trained to maintain the proper use of medicine in all healthcare settings. There is currently limited knowledge on the effects of pharmacist-led remote monitoring in managing patients with hypertension (HTN) and on which patient groups would benefit most from the service. Our study analyzes outcomes from Project Hope, a HTN randomized controlled trial (RCT), through Henry J. Austin Health Center (HJAHC), a federally qualified health center (FQHC). HJAHC started Project Hope to determine the extent to which remote blood pressure monitoring and the inclusion of a pharmacist-led intervention during therapy will impact blood pressure results in patients with risk-enhancing conditions. The purpose of this analysis is to assess whether evidence-based therapy was more frequently implemented after an intervention from a pharmacist as compared to usual care in patients with uncontrolled hypertension provided with remote blood pressure monitoring devices. The primary endpoint is the change in percentage of patients who are on HTN guideline-based therapy compared between the intervention and control arms from baseline to six months. Secondarily, we will evaluate the impact of pharmacist-led intervention on improving compliance to guideline-based pharmacotherapy based on risk-enhancing condition prompting enrollment and change in blood pressure between the two arms.

Methods: This study is conducted at HJAHC and approved by HJAHC’s Institutional Review Board. Patients who were enrolled in the RCT have met the following criteria: (1) signed the informed consent form, (2) diagnosed with uncontrolled HTN (blood pressure ≥ 140/90), and (3) have at least one of three risk-enhancing conditions (chronic kidney disease (CKD), congestive heart failure (CHF), and/or resistant HTN). Upon enrollment, patients were randomized in a 1:1 ratio to either the control (usual care) or intervention (pharmacist-led intervention) arm. Baseline information was collected after 4 weeks of enrollment for both randomized groups, and the intervention period began after the baseline information was gathered. After the first six months, a crossover will occur. This study will determine the quality of medication therapy used by each patient at the end of the first six months and compare the results between each group. Study investigators will utilize the results from electronic health records and self-monitored blood pressure devices to gather and interpret data. The primary endpoint will be reported using descriptive statistics. Change in blood pressure between the control and intervention arms over the first six months will be compared using a difference-in-difference estimation technique conducted using STATA/R statistical software. Patients enrolled in the study between February 14, 2023 and June 23, 2023 will be included in this analysis.

Results: There was a total of 134 patients enrolled during the time of interest. Of these patients, 8 have been removed from the study (4 withdrew consent, 1 is seeing an outside primary care provider, 1 became incarcerated, 1 was already receiving management from the pharmacist, 1 did not meet the inclusion criteria). Therefore, 126 patients will be included in the analysis of whom 59 are in the control arm and 67 are in the intervention arm. One hundred and three patients were enrolled for CKD, 23 for CHF, and 69 for resistant HTN.

Conclusions: The effectiveness of the pharmacist-led intervention in ensuring that patients with uncontrolled HTN with one or more risk-enhancing conditions are on guideline-based therapies is to be determined.