Teamwork and Hypertension
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Teamwork and Hypertension

August 29, 2019


>>HIGH BLOOD PRESSURE, OR HYPERTENSION, IS A LEADING RISK FACTOR FOR HEART ATTACK, STROKE, AND OTHER CARDIOVASCULAR PROBLEMS. ALONGSIDE LIFESTYLE CHANGES, HIGH BLOOD PRESSURE CAN BE MANAGED WITH MEDICATION. BUT USING MEDICINE EFFECTIVELY IS CHALLENGING WHEN DOCTORS AND PHARMACISTS WORK SEPARATELY. RESEARCH FROM THE UNIVERSITY OF IOWA SUPPORTS A NEW APPROACH. BARRY CARTER IS A PROFESSOR AT THE UNIVERSITY OF IOWA COLLEGE OF PHARMACY. HIS RECENT WORK FOCUSES ON PHARMACY/PHYSICIAN COLLABORATION TO TREAT HYPERTENSION.>>ONE OF THE PROBLEMS WITH HIGH BLOOD PRESSURE IS THAT, FOR ANY GIVEN PATIENT, WE DON’T KNOW EXACTLY WHAT’S GOING TO BE MOST EFFECTIVE, AND SO THERE’S A LOT OF TRIAL AND ERROR, SWITCHING MEDICATIONS, ADJUSTING DOSES, TO GET TO THE PROPER GOAL. THAT TAKES A FAIR AMOUNT OF TIME, AND IT CAN BE TEDIOUS, AND SO IT’S OFTEN DIFFICULT FOR PATIENTS AND PHYSICIANS TO ACCOMPLISH THOSE BLOOD-PRESSURE ADJUSTMENTS IN A REASONABLE PERIOD OF TIME. WE ALSO KNOW THAT WE CAN REDUCE THE AMOUNT OF HEART ATTACKS AND STROKES IF WE GET BLOOD PRESSURE CONTROLLED QUICKLY, USUALLY WITHIN THE FIRST SIX MONTHS TO NINE MONTHS.>>TO APPLY THE IDEA OF TEAM-BASED CARE TO THE PROBLEM OF HYPERTENSION, DR. CARTER AND HIS COLLEAGUES STUDIED SEVERAL HUNDRED PATIENTS BEING TREATED FOR HIGH BLOOD PRESSURE AT COMMUNITY CLINICS AROUND IOWA. HALF OF THE GROUP RECEIVED CONVENTIONAL TREATMENT FOR HIGH BLOOD PRESSURE, A DOCTOR WRITING A PRESCRIPTION AND A PHARMACIST SIMPLY FILLING IT. IN THE OTHER GROUP, DOCTORS AND PHARMACISTS WORKED TOGETHER, WITH CLINICAL PHARMACISTS MAKING DRUG-THERAPY RECOMMENDATIONS TO PHYSICIANS. THE RESULTS WERE COMPELLING. AFTER SIX MONTHS, BLOOD PRESSURE HAD DROPPED TO NORMAL LEVELS IN 30% OF THE GROUP RECEIVING TYPICAL TREATMENT. BUT IN THE GROUP TREATED BY PHARMACIST/PHYSICIAN TEAMS, MORE THAN TWICE THAT — 64% — RETURNED TO NORMAL BLOOD-PRESSURE LEVELS.>>THE REASON THAT THIS MODEL, WE THINK, HAS BEEN SO SUCCESSFUL IS BECAUSE WITH GREATER ATTENTION THE PHARMACIST CAN FOCUS ON IT AND MAKE MEDICATION CHANGES EARLY AND OFTEN TO ASSIST THE PHYSICIAN IN THIS ENDEAVOR. WE THINK THAT’S THE PRIMARY REASON THAT OUR MODEL HAS BEEN EFFECTIVE. THE RESEARCH THAT LOOKS AT PHYSICIAN AND PHARMACIST COLLABORATIVE MODELS IS NOT NEW. IT HAS BEEN GOING ON FOR 20 OR 30 YEARS. WHAT IS NEW ABOUT OUR RESEARCH IS THAT WE’VE CONTROLLED FOR A LOT OF VARIABLES THAT OTHER STUDIES DIDN’T COLLECT AND DIDN’T CONTROL FOR.>>DR. CARTER SAYS AN IMPORTANT IMPLICATION OF THE STUDY IS THAT TEAM-BASED CARE CAN BE APPLIED TO OTHER CHRONIC MEDICAL CONDITIONS. TO CARTER AND HIS COLLEAGUES, ISSUES LIKE RISING HEALTHCARE COSTS, AN AGING BOOMER POPULATION, AND A SHORTAGE OF PRIMARY-CARE PHYSICIANS ARE FORCING US TO LOOK AT NEW MODELS FOR DELIVERING HEALTHCARE.>>I THINK THAT IT’S ESSENTIAL THAT WE START TO WORK IN TEAMS, LARGER TEAMS THAN WE’VE STUDIED. WE’VE FOCUSED VERY, VERY EXCLUSIVELY ON PHARMACISTS AND PHYSICIANS, BUT NURSES AND MANY OTHER INDIVIDUALS ON THE HEALTHCARE TEAM ARE CRITICAL IF WE’RE GONNA TRY TO ACHIEVE WHAT WE WANT TO ACHIEVE WITH HEALTHCARE IN THE FUTURE.>>WHILE THEIR RECENT FINDINGS WERE PROMISING, CARTER AND OTHERS ARE NOW LOOKING AT USING THIS COLLABORATIVE APPROACH ON A MUCH WIDER SCALE.>>WE BELIEVE THAT, BASED ON OUR PRIOR RESEARCH AND THE RESEARCH OF OTHERS — THAT OUR MODEL FOR THIS COLLABORATIVE MANAGEMENT IN HYPERTENSION IS EFFECTIVE. WHAT WE DON’T KNOW IS, WILL IT REALLY BE IMPLEMENTED AND ADOPTED ON A BROAD SCALE? CAN IT BE? AND SO, OUR RESEARCH RIGHT NOW, FUNDED BY THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, IS STUDYING 31 CLINICS AROUND THE COUNTRY, COAST TO COAST, AND IS REALLY EXAMINING WHETHER OR NOT — NOT SO MUCH THAT THE MODEL WORKS, BUT WILL PHYSICIANS AND PHARMACISTS — IN BUSY OFFICE PRACTICES THAT HAVE A LOT OF OTHER THINGS GOING ON, WILL THEY ACTUALLY ADOPT THE MODEL, USE THE MODEL, AND WILL THAT LEAD TO BETTER BLOOD-PRESSURE OUTCOMES IN THEIR PATIENTS? SO OUR GOAL IS TO CONTINUE TO PUSH THE HORIZONS OF THAT TYPE OF RESEARCH, AND CERTAINLY FOR US HERE AT THE UNIVERSITY OF IOWA, AND IF I CAN SPEAK FOR MY RESEARCH TEAM, YOU KNOW, WE WANT TO LEAD THAT EFFORT.

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