2025 Southeastern Residency Conference

Title: Evaluating Anti-Hypertensive Management Amongst African American Patients through Inpatient and Outpatient Pharmacist Collaboration 
 
Authors: Lindsey Katsaros, Nathan Batchelder, Michelle Turner, Jimmy Wyland 
 
Background:  
In 2022, Cone Health identified a health equity gap in their community revealing lower rates of hypertension control among African American patients compered to White patients. The Collaboration Among Pharmacist and Physicians to Improve Outcomes Now trial found that pharmacist-involvement in outpatient clinic visits improved blood pressure management and reduced racial and socioeconomic disparities in blood pressure control. Cone Health launched an initiative in 2023 to eliminate this health equity gap in their surrounding community. This initiative started with blood pressure screenings and ambulatory care pharmacist visits for hypertension management. The objective of this study is to assess the impact of collaborative hypertension management interventions led by pharmacists starting in the acute care setting.  
 
Methods: 
This was an IRB approved and determined exempt evaluation assessing acute care pharmacist transitions of care interventions across four community hospitals and two emergency department medical centers. Patients were included if they were at least 18-years old, African American, had a diagnosis of hypertension, on Managed-Medicaid, and presented to an acute care facility for an emergency or hospital visit within the enrollment period of April 2024-October 2024. Patients were excluded if they were pregnant, had end-stage renal disease, or were receiving hospice or palliative care. This study assessed outcomes in patients with and without a pharmacist intervention. Pharmacists were alerted of eligible patients via the electronic medical record. Pharmacist interventions were identified by documented i-vents within the electronic medical record. The interventions assessed included providing bedside education on adherence, enrolling patients in Meds-to-Beds delivery prior to hospital discharge, and referring patients to an ambulatory care pharmacist for further blood pressure management. The primary endpoint was the number of acute care visits, including hospital readmission and emergency room visits, within 90 days in patients who were reviewed and offered a pharmacist intervention compared to patients who were not reviewed by a pharmacist. Secondary objectives included the number and type of medication barriers identified and the number of patients who accepted pharmacy services, including Meds-to-Beds delivery and ambulatory care clinic referrals. 
 
Results:  
A total of 454 patients were evaluated; 30 patients were reviewed by a pharmacist, and 424 patients were not reviewed by a pharmacist. Majority of patients were female (n=272, 60%) with an average age of 48 years old. Patients with a pharmacist review had a higher average number of acute care visits within 90 days compared to patients without a pharmacist review (2.2 vs 0.57 acute care visits in 90 days, p=0.0036). Of the 30 patients with a pharmacist review, a total of 20 patients accepted a pharmacist intervention. The most common interventions were education provided by the pharmacist (n=16, 53%) and referral sent for an ambulatory care pharmacist appointment (n=15, 50%). A subgroup analysis of patients who had a pharmacist review found that patients with an ambulatory care referral, compared to patients without an ambulatory care referral, had fewer emergency department visits within 90 days (1.1 vs 2.2 visits in 90 days) and fewer re-hospitalizations within 90 days (1.3 vs 3.1 visits in 90 days).  
 
Conclusion:  
For African American patients with hypertension, this study did not find any reduction in acute care visits when an acute care pharmacists conducted a formal review of patient's hypertension management. There was a reduction in emergency department visits and re-hospitalizations seen when patients were referred to follow-up with an ambulatory care pharmacist. The results from this study further support the efforts of ambulatory care pharmacists to help manage hypertension in the outpatient setting. Further efforts should be made to streamline the process of referring patients to a pharmacist for a post-discharge ambulatory care appointment.