Objectives

Using a physician/pharmacist collaborative management (PPCM) approach to patient care, the CAPTION study investigated if blood pressure (BP) control of ethnically diverse and geographically distributed populations, could be better managed. In an asthma sub-study, researchers also investigated if using a PPCM approach could reduce the number of emergency department (ED) visits and hospitalizations.

Background

Chronically elevated blood pressure and asthma are two conditions, when uncontrolled, can lead to serious complications, often requiring hospitalization and extensive medical interventions. If detected early and managed properly, hospital visits are reduced and medical costs are better contained. For a variety of reasons though, asthma and blood pressure control are not always achieved by community level, primary-care physicians making hospital visits unavoidable.

Previous studies indicate that when a pharmacist is part of a community physician practice, patients have better BP control than those whose primary care team does not include a pharmacist. This PPCM approach to patient care allows pharmacists to have a more active role by assisting with the screening, education, and medication management of hypertensive patients.

Participants

Hypertension study: 625 participants were enrolled in the CAPTION study. Enrollees were male or female, 18 years of age or older, and had a diagnosis of hypertension. Fifty-four percent of participants were from racial/ethnic minority groups and 50% also had a diagnosis of diabetes mellitus or chronic kidney disease (CKD). To qualify, participants needed to have a systolic blood pressure (SBP) of greater than 140 mm Hg or a diastolic blood pressure (DBP) of greater than 90 mm Hg. Participants with diabetes or CKD could qualify with a SBP of greater than 130 or a DBP greater than 80. Disqualifying factors included pregnancy, history of MI, stroke or unstable angina 6 months prior to enrollment, severe hypertension (SBP >200 or DBP > 114 mm Hg), or an ejection fraction (EF) < 35%. Those with pulmonary HTN, sleep apnea, or cognitive impairment were also excluded from enrollment.

Asthma study: 126 male or female participants, ages 12 or older, with a diagnosis of asthma were enrolled in the study. Patients with severe asthma, who had a history of needing mechanical ventilation, or were likely to be managed by a pulmonologist were excluded. A diagnosis of chronic obstructive pulmonary disease (COPD), pregnancy, or cognitive impairment were additional disqualifiers.

Design

Hypertension study: The CAPTION study was a 5 year, prospective, cluster-randomized, multi-center clinical trial where 32 primary care offices in 13 states had an onsite pharmacist. Offices were randomized such that 9 were assigned to the 9-month (brief intervention [BI]) group, 11 were assigned to the 24-month (sustained intervention [SI]) group, and 12 offices were assigned to the usual or control group.

Participants in either of the blood pressure intervention groups were to receive the same intervention for the first 9 months, at which point, the BI group received care similar to those in the control group. The primary outcome was to examine if during a 9-month period, BP could be better controlled for participants in a PPCM intervention group than for those in a control group. The secondary outcome examined if long-term blood pressure control was better achieved for participants in the sustained intervention group when compared to those in the brief intervention or control groups.

Baseline data for the blood pressure study included height, weight, pulse, duration of hypertension, presence of other cardiovascular risk factors, and current medications. Blood pressure was also measured three times during the baseline visit as well as during intervals 6, 9, 12, 18, and 24 months. All BP measurements were taken in a sitting position, one minute apart.

Asthma study: The asthma arm was a prospective pre-post study where 11 of the 12 CAPTION blood pressure ‘control’ offices, were also assigned to the Asthma PPCM study. Participants in each office were assigned to an intervention or control group and those in the asthma intervention group received 9 months of PPCM intervention. The primary outcome was to determine if a reduction in the number of asthma-related ED visits and hospitalizations could be sustained after 9 months of PPCM interventions.

Baseline, 9-month, and 18-month data was collected for the asthma study participants and included demographic information, asthma medications, and number of visits to the clinic or ED. Asthma Control Test (ACT) scores and Asthma Quality of Life Questionnaires (AQLQ-M) were also obtained each data collection period.

Conclusions

Although there was not a significant difference between the control and intervention groups within the initial 9-month period of the study, sustained blood pressure reduction was evident for minority and white participants in intervention groups even after interventions were discontinued. These findings suggest that the physician/pharmacist collaborative approach to blood pressure control is beneficial when implemented in primary care offices with greater racial diversity.

The primary outcome for all patients in the asthma study was also negative but for patients in the PPCM group who were identified as having uncontrolled asthma at baseline, a significant reduction in the number ED visits and hospitalizations was evident.

Request Data

Please note that researchers must be registered on this site to submit a request, and you will be prompted to log in. If you are not registered on this site, you can do so via the Request button. Registration is quick, easy and free.