Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension.
STUDY OBJECTIVE
Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists' work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists' work in the management of hypertension with a physician-pharmacist collaborative model.


DESIGN
Descriptive analysis of the components of pharmacists' work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial.


MEASUREMENTS AND MAIN RESULTS
This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists' work to understand pharmacists' relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients' blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point).


CONCLUSION
Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists' work in value-based financing and population management.
['Isetts|Brian J|BJ|', 'Buffington|Daniel E|DE|', 'Carter|Barry L|BL|', 'Smith|Marie|M|', 'Polgreen|Linnea A|LA|', 'James|Paul A|PA|']
D000368:Aged D000959:Antihypertensive Agents D002318:Cardiovascular Diseases D014487:Centers for Medicare and Medicaid Services, U.S. D003131:Combined Modality Therapy D003365:Costs and Cost Analysis D016903:Drug Monitoring D005260:Female D017048:Health Care Costs D000070497:Healthy Lifestyle D006801:Humans D006973:Hypertension D000070516:Intersectoral Collaboration D008297:Male D055118:Medication Adherence D010348:Patient Care Team D018802:Patient-Centered Care D010595:Pharmacists D058007:Physicians, Primary Care D017410:Practice Guidelines as Topic D012307:Risk Factors D014481:United States D000078329:Workforce
blood pressure control hypertension management pharmacist management