High blood pressure causes a slew of health problems, and physicians, pharmacists and researchers are always seeking new ways to control it.
Recently, the Centers for Disease Control recognized University of Michigan Medical Group as having the top hypertension control program in the country that incorporates team-based pharmacy care. For the next two years, the CDC will evaluate the program, with the goal of sharing a replicable model nationally. UMMG hypertension program was chosen for the CDC partnership from 39 nominations around the country.
Roughly 40,000 patients today at U-M clinics have hypertension, and for years, only 72 percent met their blood pressure targets, said Hae Mi Choe, UMMG chief quality officer and associate dean of U-M college of pharmacy. The goal of most health systems is 75 percent.
Then, 18 months ago, Michigan Medicine implemented a team-based approach to lowering hypertension, and the number of patients meeting their blood pressure targets rose to 78 percent, said Choe, also the director of pharmacy innovations and partnerships for the UMMG.
“If you think about it, there are 40,000 patients in our system who have hypertension, and improving blood pressure control by one percent is 400 patients. Budging that many patients by six percent is quite an accomplishment,” she said. “I think all clinicians and payers would agree it’s important.”
At the core of the program are the pharmacists embedded in the 14 primary care clinics, who work together with physicians to help patients manage high blood pressure. Patients who need extra help are referred to a clinic pharmacist, and they meet with them just like they meet with their primary care physician.
The CDC also liked the partnership between the clinics and Meijer, in which patients can visit a specially trained pharmacist in at one of three Meijer pharmacies, and avoid a longer trip to their PCP. Those selected pharmacists have access to the patient’s medical records and can document important updates to those charts. In this way the primary care physician and pharmacists are always in sync with the treatment plan.
Other components of the program include rechecking blood pressure by the medical assistants if the initial patient reading is high, and about 30 percent of the readings are normal the second time, Choe said. If the second reading is still high, the patient is scheduled for a follow up blood pressure appointment.
Also, an interactive phone system prompts patients to take their own blood pressure, and if their levels aren’t on target, a clinic pharmacist follows up by calling the patient at home.
UMMG started embedding pharmacist in clinics in 1999, said Choe, who built the first pharmacist-driven clinic. In 2009, they replicated the model and put pharmacists in every primary care clinic.