(1019) Effect of a Community Pharmacy Cardiovascular Practice Transformation (CPT) Program on Blood Pressure

Objectives: In the United States, 48.1% of the population has hypertension, and 75% of them have uncontrolled blood pressure. Community pharmacists, with their expertise and accessibility, are an underutilized resource in addressing this issue. A Cardiovascular Practice Transformation (CPT) program was designed to guide community pharmacies in implementing changes to support longitudinal monitoring of patients with cardiovascular conditions such as hypertension. The CPT program took ideas from the Flip the Pharmacy initiative developed by the Community Pharmacy Enhanced Services Network (CPESN) USA. Flip the Pharmacy has been associated with community pharmacy practice transformation to support new service delivery. The CPT program was developed to enhance the ability of CPESN Iowa pharmacies to help manage blood pressure through longitudinal monitoring.

Objectives: (1) To implement the CPT program and evaluate its impact on blood pressure and (2) To assess the feasibility of implementing the CPT program by describing obstacles and facilitators.

Methods: For this project, 23 pharmacies participated in the CPT program. The components of the CPT program were peer coaching of pharmacists, online change packages guiding practice transformation and performance feedback through a project dashboard. Each pharmacy was asked to monitor 10 patients with hypertension for up to six months. During CPT visits with patients the pharmacists checked blood pressure, assessed medication adherence, identified medication-related problems (MRPs) and took action to address the identified problems. Pharmacists reported their CPT activities using a project JotForm application. The JotForm collected two types of reports: baseline and follow-up. The baseline report gathered essential patient information, including demographics and medication usage, as well as a description of any care provided during the initial visit. Follow-up reports documented care activities and any additional patient information obtained during subsequent visits, including blood pressure readings.
After the CPT program operated for about 6 months, a link to an online (Qualtrics) survey was sent to each of the pharmacies participating in the CPT program to assess the obstacles and facilitators to implementing the program. For analyses, descriptive statistics were calculated for the patient sample, while baseline and the last follow-up blood pressure readings were compared using paired t-tests. Also, frequencies were calculated for obstacles and facilitators to implementing the CPT program.

Results: The baseline data included 232 patients from 23 pharmacists, with a median age of 62.4 years. Of these patients, 53.4% were males and 92.7% identified as Caucasian or White. On average, these patients were prescribed 7 chronic medications per month. Out of 197 patients diagnosed with hypertension, 138 had both baseline and follow-up measurements. Therefore, a total of 138 patients were included in the blood pressure analyses.
Both systolic and diastolic blood pressure readings decreased significantly from baseline to the last follow-up BP reading. Mean (SD) systolic BP decreased from 144.2 (21.3) to 133.6 (18.5), while mean diastolic BP decreased from 84.4 (13.2) to 78.3 (11.3). Both of these decreases were statistically significant at p< 0.01.
The most common facilitators of the CPT program were CPT change packages and CPT coaching at 87%, followed by the CPT dashboard at 78.3%, and CPT Jot Form at 73.9%. Access to patient information and communication with providers were reported by 60.9% of participants as facilitators.
The most common obstacle was service documentation (73.9%). Staff time, lack of reimbursement, and workflow changes were also noted as obstacles, with percentages of 69.6%, 65.2%, and 56.5%, respectively.

Conclusions: The pharmacists participating in the CPT program helped lower patients' blood pressure. The practice changes guided by the program supported the pharmacists in monitoring blood pressure longitudinally. Key facilitators were providing information for practice transformation through change packages and peer coaching.