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.
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.
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
Pharmacists received a discussion guide, a tool to
identify patients' barriers to medicine adherence, a
poster, and a guide on taking blood pressure and
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)
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
- 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,
Participating pharmacies named two significant barriers:
- Burden on staff in adding one more program to a busy
- Patient buy-in of the importance
of lowering high blood pressure and the project's
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
- Medication Adherence – CDC Operationalized
1305 Performance Measure
- Medication Tracker for patients
- Success Story
- "Team Up. Pressure Down." Pharmacist Pocket Guide
Carrie S. Oser, MPH, Epidemiologist
Montana Department of Public Health and Human Services
Chronic disease management
November 27, 2017
Date updated or reviewed
November 30, 2022
Suggested citation: Rural Health Information Hub,
Montana "Team Up. Pressure Down." Blood Pressure Medication Adherence Project [online]. Rural Health Information Hub. Available at:
[Accessed 5 February 2023]
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