Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial.
Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial.
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DOI：
10.1161/circulationaha.111.089169
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发表时间：
2012-06-12
期刊：
影响因子：
37.8
通讯作者：
Kerr EA
中科院分区：
文献类型：
--
作者：
Heisler M;Hofer TP;Schmittdiel JA;Selby JV;Klamerus ML;Bosworth HB;Bermann M;Kerr EA
Even in high performing health systems, some hypertensive patients with diabetes have persistent poor blood pressure (BP) control. Medication nonadherence and lack of medication intensification contribute to this poor control. We examined whether the Adherence and Intensification of Medications (AIM) intervention, a targeted pharmacist-led intervention that combined state-of-the-art elements found in efficacy studies to lower BP, could improve BP among diabetes patients with persistent hypertension and poor refill adherence or insufficient medication intensification. We conducted a prospective, multi-site cluster randomized pragmatic trial with randomization of 16 primary care teams at five medical centers (3 Veterans Affairs [VA] and 2 Kaiser Permanente [KP]) to the AIM intervention or usual care. The primary outcome was the relative change in systolic blood pressure (SBP) measurements, comparing 1,797 eligible intervention team patients to 2,303 eligible control team patients, between the 6-months preceding and the 6-months following the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. In our primary analysis, the intervention group SBP change from 6-months prior to 6-months after the 14-month intervention period was approximately the same as the control group, declining approximately 9 mm Hg in both groups. SBP lowering occurred more rapidly among eligible intervention team patients, with mean SBPs 2.4 mm Hg lower (95% CI: −3.4 to −1.5; p<.001) immediately after the intervention than those achieved by eligible control patients. The AIM program more rapidly lowered SBPs among eligible intervention patients, but there was no significant difference in blood pressure between intervention and control patients 6 months following the intervention period. These findings show the importance of rigorously evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings.
