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University of Iowa News Release

Dec. 5, 2003

Studies Looking At Team Approach To Improve Hypertension Treatment

The University of Iowa College of Pharmacy has been awarded two grants totaling $5.2 million to evaluate the impact of physician-pharmacist collaborative teams on adherence to blood pressure guidelines.

A five-year, multi-center study titled, "Improving Adherence to Blood Pressure Guidelines," is funded for $3.3 million by the National Institutes of Health (NIH). A three-year study, "Collaborative Management of Hypertension," has been awarded $1.9 million, also from the NIH.

Barry L. Carter, Pharm.D., UI professor and head of the College of Pharmacy's clinical and administrative pharmacy division, is principal investigator for both studies. Carter, who also is a professor of family medicine in the UI Roy J. and Lucille A. Carver College of Medicine, has extensive experience conducting studies of adherence to hypertension guidelines, physician prescribing practices and physician-pharmacist collaboration.

Blood pressure control in the United States remains poor, with only 34 percent of the 50 million Americans with hypertension currently achieving a "goal" blood pressure, Carter noted. Six sets of clinical practice guidelines on the management of hypertension have been disseminated over the last 30 years, each providing physicians with extensive recommendations for managing blood pressure. However, according to Carter, "clinical guidelines, by themselves, often fail to change physician practice."

The "Improving Adherence to Blood Pressure Guidelines" study will be conducted at six family medicine clinics in Sioux City, Des Moines (two sites), Mason City, Waterloo and Davenport. Each site will be randomly assigned to either an intervention or a control group. The first phase of the study will identify the scope of non-adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7), which sets the standards by which blood pressure management is judged. Prescription information will be collected for 450 patients with hypertension. A case abstract, detailing the care each patient received, will be prepared and evaluated using adherence criteria established by an expert panel. These data will be used to describe the current state of practice and will serve as a baseline assessment for the intervention component of the study.

The second phase of the study will assess the impact of physician-pharmacist interventions on hypertension guideline adherence and blood pressure control. Ten physicians at each family medicine clinic will participate in the study. A total of 720 patients with poorly controlled hypertension will be recruited.

The three intervention sites will implement a collaboration intervention to improve care for patients at the intervention sites. A clinical pharmacist will evaluate each patient and provide education and patient-specific recommendations to the physician at the beginning of the study, at one month and at three months. Physicians and pharmacists will work together to establish treatment goals and achieve blood pressure control. Clinical pharmacists will work to educate physicians about JNC 7 guidelines and to provide feedback concerning adherence to the guidelines.

The collaboration intervention constitutes an innovative approach to care, Carter noted. "We expect the vast majority of physicians to have favorable attitudes about clinical pharmacy services. However, physicians are not generally accustomed to the intensive intervention and collaboration we will institute," he said.

Patients at the control sites will receive care as is usual at their clinics. This care may or may not include a pharmacist evaluation or recommendation.

The primary outcomes to be measured by the study are physician adherence to guidelines and physician knowledge of recommended practices for treating hypertension. It is anticipated that physician adherence to blood pressure guidelines, as measured by the adherence criteria, will be significantly greater for intervention patients than for control-group patients. Physician knowledge of recommended practices, as measured by a questionnaire, is expected to be higher for intervention site physicians than for control site physicians, Carter said.

A secondary outcome measure will be patient blood pressure levels at the beginning of the study, at three months and at six months. Blood pressure goals will be determined using patient risk factors and a stratification scheme according to JNC 7. It is anticipated that patients in the intervention group will exhibit significantly greater improvement in blood pressures than patients in the control group, Carter said.

Carter's "Collaborative Management of Hypertension" study will include a similar intervention to improve blood pressure control. This study will involve five family medicine and internal medicine clinics in North Liberty, Lone Tree and Iowa City.

In both studies, data will be collected on the extent of physician-pharmacist collaboration at each of the study sites.

"We expect collaboration to be higher at the experimental sites than at the control sites," Carter said. "In addition, even through the intervention is specific, each physician-pharmacist team will likely negotiate roles and responsibilities depending on the physician's practice style and philosophy."

Carter anticipates that the expected improvement in guideline adherence and reduction in blood pressure with this intervention will significantly impact patients with hypertension. Thus, the collaboration intervention has the potential to become an important strategy for improving blood pressure for more than 37 million Americans with uncontrolled hypertension, he said.

STORY SOURCE: University of Iowa Health Science Relations, 5135 Westlawn, Iowa City, Iowa 52242-1178

MEDIA CONTACT: David Pedersen, 319-335-8032, david-pedersen@uiowa.edu