Evaluation of Blood Pressure Control and Quality Measure Performance Following Pharmacist Hypertension Management in the Primary Care Setting
by Jordyn T. Kettner, 2022 PharmD Candidate, Laura I. Belmonte, PharmD, Katherine J. Hartkopf, PharmD, BCACP, April J. Weaver, PharmD, BCACP, Kristina M. Heimerl, PharmD, BCACP
"Objective: The impact of primary care pharmacists practicing under a hypertension management protocol at a health system is captured by the state quality measure benchmark of blood pressure measurement less than 140/90 mmHg. However, this measure does not manage factors that may result in inaccurate reporting of patient hypertension control. This quality improvement project was designed to evaluate why prior pharmacist- managed patients had recent in-clinic blood pressure measurements above goal, and to identify opportunities for improvement.
Methods: A report was generated to identify family medicine patients with a most recent blood pressure measurement above goal following participation in the pharmacist hypertension management program. A retrospective chart review was conducted, and reasons for above goal in- clinic blood pressure measurements were categorized. Additional factors were collected for all patients and analyzed for patients categorized as unknown to identify trends.
Results: Of the 141 patients evaluated, the most common reason for above goal in-clinic blood pressure was white coat hypertension (38%). Of the patients without an identifiable cause for elevated blood pressure (9%), almost half had a history of non-adherence to medications.
Conclusions: For patients with hypertension, there are reasons for above goal in-clinic blood pressures deemed not controlled with the state quality measure. Opportunity exists to capture hypertension control more accurately within health systems with use of home readings, as well as to re-evaluate blood pressure management strategies and adherence for patients without an identifiable reason for uncontrolled hypertension."
Keywords: Adult, Antihypertensive Agents, Blood Pressure, Pharmacists, Quality Indicators, Health Care, Benchmarking, Quality Improvement, Cause of Death, Family Practice, Goals, Retrospective Studies, Sedentary Behavior, White Coat Hypertension, Wisconsin, Hypertension, Medication Adherence, Stroke, Patient Care Team, Physicians, Heart Failure, Coronary Disease, Chronic Disease, Heart Diseases, Patient Care, Primary Health Care, Risk Factors, Morbidity, Diet
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2022 September/October Table of Contents
"Objective: The impact of primary care pharmacists practicing under a hypertension management protocol at a health system is captured by the state quality measure benchmark of blood pressure measurement less than 140/90 mmHg. However, this measure does not manage factors that may result in inaccurate reporting of patient hypertension control. This quality improvement project was designed to evaluate why prior pharmacist- managed patients had recent in-clinic blood pressure measurements above goal, and to identify opportunities for improvement.
Methods: A report was generated to identify family medicine patients with a most recent blood pressure measurement above goal following participation in the pharmacist hypertension management program. A retrospective chart review was conducted, and reasons for above goal in- clinic blood pressure measurements were categorized. Additional factors were collected for all patients and analyzed for patients categorized as unknown to identify trends.
Results: Of the 141 patients evaluated, the most common reason for above goal in-clinic blood pressure was white coat hypertension (38%). Of the patients without an identifiable cause for elevated blood pressure (9%), almost half had a history of non-adherence to medications.
Conclusions: For patients with hypertension, there are reasons for above goal in-clinic blood pressures deemed not controlled with the state quality measure. Opportunity exists to capture hypertension control more accurately within health systems with use of home readings, as well as to re-evaluate blood pressure management strategies and adherence for patients without an identifiable reason for uncontrolled hypertension."
Keywords: Adult, Antihypertensive Agents, Blood Pressure, Pharmacists, Quality Indicators, Health Care, Benchmarking, Quality Improvement, Cause of Death, Family Practice, Goals, Retrospective Studies, Sedentary Behavior, White Coat Hypertension, Wisconsin, Hypertension, Medication Adherence, Stroke, Patient Care Team, Physicians, Heart Failure, Coronary Disease, Chronic Disease, Heart Diseases, Patient Care, Primary Health Care, Risk Factors, Morbidity, Diet
Download PDF
2022 September/October Table of Contents