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Rural Health Information Hub

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)


Rural patients with high blood pressure may face barriers, such as 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 conducted an intervention to see how participants could help patients adhere to their medication.

MCHP logo

From February 2014 to June 2018, pharmacists in 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).

Services offered

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.


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.


During the five-year project, 36 community pharmacies (located in a retail setting instead of a hospital) participated in Montana's TUPD program. In year one, a pilot project was conducted with 8 pharmacies. Because the pharmacies did not use a standardized medication adherence definition, year one data are not included in these aggregate results.

Each participating pharmacy calculated blood pressure medication adherence (using a standardized definition of proportion of days covered greater than or equal to 80%) for its selected population. For years 2-5 of the project:

  • 926 patients were tracked.
  • 86% of participants adhered to their blood pressure medication, compared to 71% pre-intervention.
  • Adherence improved in 24 of the 28 participating pharmacies.

For more information:

Oser, C.S., Fogle, C.C., & Bennett, J.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).


Participating pharmacies named two significant barriers:

  • Burden on staff in adding one more program to a busy schedule
  • 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 scheduled a conference call so an experienced pharmacist could coach newly participating pharmacists. Involving a consulting pharmacist with subject matter expertise enhanced credibility when recruiting pharmacies for the project and facilitating technical assistance during implementation.

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 include:

  • 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

Contact Information

Carrie S. Oser, MPH, Epidemiologist
Montana Department of Public Health and Human Services

Cardiovascular disease
Chronic disease management
Pharmacy workforce

States served

Date added
November 27, 2017

Date updated or reviewed
November 30, 2022

Suggested citation: Rural Health Information Hub, 2022. Montana "Team Up. Pressure Down." Blood Pressure Medication Adherence Project [online]. Rural Health Information Hub. Available at: [Accessed 30 May 2023]

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.