Montana "Team Up. Pressure Down." Blood Pressure Medication Adherence Project
- Need: To help rural Montana patients manage their blood pressure levels.
- Intervention: Pharmacists distributed "Team Up. Pressure Down." materials from the Million Hearts Initiative and provided consultations.
- Results: 89% of patients were able to adhere to their blood pressure medication, compared to 73% before the intervention.
Effective (About evidence-level criteria)
In 2015, 29.1% of adults in Montana reported having high blood pressure. This percentage ranged from 27.1% of adults in some parts of the state to 33.9% of adults in the eastern, rural part of the state.
Rural patients with high blood pressure may face barriers, like financial difficulties, that prevent them from regularly taking their medication. Since patients picking up a monthly prescription may see a pharmacist more often than they see their primary care provider, the Montana Cardiovascular Health Program at the Montana Department of Public Health and Human Services (MDPHHS) conducted an intervention to see how participants could help patients adhere to their medication.
From February 2014 to June 2016, pharmacists in rural Montana distributed the Million Hearts Initiative's "Team Up. Pressure Down." (TUPD) materials and provided consultations to their patients taking medication for high blood pressure.
The project received support from the Centers for Disease Control and Prevention (CDC).
Consultations: Pharmacists met with each patient to discuss medicine management, blood pressure control, and possible barriers. If a patient smoked, the pharmacist referred them to the Montana Tobacco Quit Line.
Distribution of materials: Pharmacists distributed "Team Up. Pressure Down." materials like a journal and a wallet-sized card to help patients keep track of prescriptions. Pharmacists also provided information about the Dietary Approaches to Stop Hypertension (DASH) program.
Pharmacists received a discussion guide, a tool to identify patients' barriers to medicine adherence, a poster, and a guide on taking blood pressure and interpreting readings.
During the three-year project, 25 community pharmacies (located in a retail setting instead of a hospital) participated in Montana's TUPD program: 8 pharmacies in year one, 11 pharmacies in year two, and 6 pharmacies in year three.
Each participating pharmacy calculated blood pressure medication adherence for its selected population, and the Montana Cardiovascular Health Program aggregated the results. For years two and three of the pilot project:
- 534 patients participated: 360 in year two and 174 in year three.
- 89% of participants adhered to their blood pressure medication, compared to 73% pre-intervention.
- Adherence improved in 15 of the 17 participating pharmacies.
For more information:
Oser, Carrie S., Fogle, Crystelle C., & Bennett, James A. (2017). A Project to Promote Adherence to Blood Pressure Medication among People who Use Community Pharmacies in Rural Montana, 2014-2016. Preventing Chronic Disease, 14(E52).
Pilot pharmacies named 3 significant barriers:
- Burden on staff in adding one more program to a busy schedule
- Challenges in obtaining enough funding
- Patient buy-in of the importance of lowering high blood pressure and the project's benefits
To reduce staff burden, participating pharmacists suggested creating a template for tracking patients, a checklist of discussion topics, and other resources. Some sites also involved the entire pharmacy staff in the project to reduce burden on the pharmacists.
Project coordinators offered two options for pharmacist training: (1) attending a hands-on workshop about blood pressure measurements, current guidelines, and medication management or (2) taking home the blood pressure curriculum. Project coordinators also scheduled a conference call so that an experienced pharmacist could coach newly participating pharmacists.
Participating pharmacists recommended directing this project to patients who were newly diagnosed with high blood pressure, as more experienced patients already knew different ways to manage their condition.
Pharmacy blood pressure resources:
- Checklist for Patient Interactions
- Explanation of "Team Up. Pressure Down." Checklist
- Map of Montana Community Pharmacies and Hypertension Prevalence
- Medication Adherence – CDC Operationalized 1305 Performance Measure
- Medication Tracker for patients
- Success Story
- "Team Up. Pressure Down." Pharmacist Pocket Guide
- Tips to Keep my Blood Pressure Down
Chronic disease management
November 27, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.