U-M hypertension pharmacists model expanding to other states

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Embedding pharmacists as part of the health care team at University of Michigan primary care clinics and community retail pharmacies has proven so effective in controlling blood pressure that the Centers for Disease Control and Prevention is expanding the model to the southeastern United States.

A CDC evaluation of U-M’s Hypertension Pharmacists’ Program found that 66% of patients who met with an HPP pharmacist had their hypertension under control within three months, compared with 42% of patients who did not meet with a pharmacist. At six months, 69% had their blood pressure under control, compared with 56% of nonparticipants.

The CDC’s Division for Heart Disease and Stroke Prevention is seeking to scale up and extend the U-M model to other regions of the country as part of its goal to close the health disparity gap by 5% among Black adults. The CDC chose the southeastern U.S. as it primarily serves African American populations at a higher risk of hypertension and uncontrolled blood pressure.

Hypertension affects nearly half of adults and 55% of African Americans — making hypertension a major contributor to heart attacks and strokes, according to the American Heart Association.

Hae Mi Choe, clinical professor of pharmacy in the College of Pharmacy and chief population health officer for Michigan Medicine, first developed the pharmacist-centric care model in 1999.

By 2009, the program had expanded to add pharmacists to clinic locations at U-M Health, and in 2017 the program moved into select Meijer store pharmacies near U-M health clinics.

The model provides patients who have hypertension, or high blood pressure, with individualized and accessible care and education provided by specially trained pharmacists in tandem with a patient’s primary care physician.

The goal is better blood pressure control with fewer primary care physician visits for hypertension issues, Choe said. While many Americans struggle to access primary health care regularly, nearly 90% of the U.S. population lives within five miles of a pharmacy, making the community pharmacist the most accessible health care provider.

“Pharmacists are an essential part of the care team, and HPP has shown they can be part of the answer to improving access to care and outcomes, too,” Choe said.

Having the pharmacist as part of the patient care team gives patients quicker access to a health care provider and frees up the time of physicians, she said.

“Any patient who is newly diagnosed with hypertension or uncontrolled blood pressure may be referred to the pharmacist for a consultation on how to manage their condition,” Choe said.

At patient consultations, HPP pharmacists discuss lifestyle factors such as diet, exercise, smoking and stress — all influencers on blood pressure. They also can identify allergies, review and adjust medications, instruct on at-home monitoring and assess factors that could keep the patient from taking prescribed blood pressure medications regularly, including cost.

High blood pressure can be virtually symptom-free and often goes undiagnosed. About 25% of those with the condition have it under control. Hypertension is controllable with the combination of medication or lifestyle changes.

In late 2023, the CDC Division for Heart Disease and Stroke Prevention invited proposals from health care systems and community pharmacy settings in the southeastern U.S. interested in implementing HPP in settings that serve African American patients. One site will be selected to implement the core components of HPP, and the CDC will evaluate outcomes.

“The program Dr. Choe and her team have built has the potential to be a game-changer in bringing pharmacists into the care team to better serve patients. We are so proud of this program and excited to further our collaboration with the CDC to help conquer hypertension throughout the country,” said Vicki Ellingrod, College of Pharmacy dean and the John Gideon Searle Professor of Clinical and Translational Pharmacy.

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