Montana "Team Up. Pressure Down." Blood Pressure Medication Adherence Project

Evidence-level

Effective (About evidence-level criteria)

Description

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 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.

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.

Results

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).

Challenges

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.

Replication

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
coser@mt.gov