Physician–Pharmacist Collaborative Management

Over 80 million American adults were diagnosed with hypertension in 2011, and there was a 39% increase in deaths related to hypertension between 2001 and 2011. Hypertension was associated with $46.4 billion in direct and indirect costs in the United States in 2011. National Health and Nutrition Examination Survey data analyses have found that individuals from under-represented minority groups or those with lower socioeconomic status related to income, insurance, and education have a higher prevalence of hypertension and worse blood pressure control. Achieving health equity across diverse populations is an important goal of Healthy People 2020. Studies have shown that socioeconomic status is a major predictor of healthcare disparities in the US population. Although efforts have been made to address these disparities, African Americans still develop hypertension at a higher rate and have a higher mortality rate for both coronary heart disease and stroke than Caucasians. Healthcare disparities result from more than racial and ethnic differences and include other components, such as socioeconomic status and rural settings, which may limit access to quality healthcare, thus influencing healthcare outcomes. Race, income, education, and insurance status are significant predictors of blood pressure control. Nationwide survey data have found that individuals with lower education or income level had higher rates of uncontrolled hypertension. An analysis of these data also found that uninsured (self-pay) individuals have a higher rate of uncontrolled hypertension compared with those publicly (Medicare, Medicaid) and privately insured. Although blood pressure control rates have improved in the overall population, socioeconomic disadvantaged populations have not improved to the same degree. Many barriers to blood pressure control exist, such as low medication adherence, limited access to care, and inadequate dosing of antihypertensive drugs. Team-based care involving pharmacists or nurses has been proven to improve hypertension control. Abstract—Physician–pharmacist collaboration improves blood pressure, but there is little information on whether this model can reduce the gap in healthcare disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate whether the pharmacist intervention could reduce healthcare disparities by improving blood pressure in high-risk racial and socioeconomic subjects compared with the control group. The analyses in minority subjects were prespecified secondary analyses, but all other comparisons were secondary, post hoc analyses. The 9-month visit was completed by 539 patients: 345 received the intervention, and 194 were in the control group. Following the intervention, mean systolic blood pressure was found to be 7.3 mm Hg (95% confidence interval 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared with the control group (P=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% confidence interval 3.2, 13.1) lower than the control group with lower education (P=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid, or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. Although disparities in blood pressure were reduced by the intervention, there were still nonsignificant gaps in mean systolic blood pressure when compared with intervention subjects not at risk. Clinical Trial Registration—URL: http://clinicaltrials.gov. Unique identifier: NCT00935077. (Hypertension. 2016;68:1314-1320. DOI: 10.1161/HYPERTENSIONAHA.116.08043.) • Online Data Supplement