A Team Model of Hypertension Care in African Americans

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Despite efficacious drug and non-drug treatments, fewer than 50% of treated African American patients achieve adequate hypertension control (<140/90 mm Hg or <130/80 mm HG for patients with diabetes or chronic kidney disease). Studies suggest many reasons for lack of progress in this area, including patient nonadherence, suboptimal prescribing, and ineffective communication among patients, physicians, and 3harmacists. This study will evaluate the cost-effectiveness of an organizational-level intervention in a randomized sontrolled trial involving 900 treated hypertensive African American patients in the Milwaukee and Chicago areas. The study will involve 36 community pharmacies (18 intervention, 18 control) owned by a pharmacy corporation that operates over 2,000 pharmacies nationwide. The intervention will include: a) redefinition of pharmacist and pharmacy technician roles, b) implementation of a pharmacy-based "refill clinic" and tools for enhanced monitoring and collaboration with patients and physicians, and c) special training/certification of pharmacy personnel in blood pressure measurement, collaborative skills, and cultural competency. Hypertension control rates (primary endpoint) will be measured at- baseline, six months, and 12 months. Researchers will analyze the cost-effectiveness of the intervention, whether the recommended practices were implemented and continued over time, and ways in which the intervention affected the process of care (including pharmacist behavior, patient-reported barriers, prescribed regimens, and patient adherence). If the intervention is successful, researchers will implemement and evaluate a dissemination plan for improving pharmacy-based care of hypertensive patients nationwide. The study is unique because it tests relatively simple and low cost interventions in the community pharmacy, an environment which is one of the most readily accessible components of the health care system.