2025 Southeastern Residency Conference

Title: Evaluating the Impact of a Community Pharmacist-Led Blood Pressure Service to Improve Hypertension Control
Authors: Tolulope Olajide, Allyson Marsh, Megan Boothby, Catie Harper, Nicole Aldaz, Claire O’Conner
Background: 
Uncontrolled hypertension is associated with increased prevalence of major adverse cardiac events. This health disparity is thought to be largely driven by disparities in Social Drivers of Health (SDOH) in this population. In 2023 Cone Health identified a systemwide disparity between the proportion of patients identifying as Black or African American with hypertension control compared to that of the general population (69.9% vs. 74.8%). A previous cohort study in our health system found pharmacy student-led patient interactions, either in person within a community pharmacy or telephonic, were associated with a significant improvement in hypertension control. As community pharmacists are one of the most accessible healthcare professionals, pharmacist-led blood pressure screenings have the potential to positively impact blood pressure control on a broader scale. The purpose of this study is to assess the impact of community pharmacist-led blood pressure screening and education on hypertension control.
Methods:
This was a single system, multi-site, IRB-exempt, retrospective cohort study. Adults diagnosed with hypertension were included if they had a recent blood pressure reading ≥ 140/90 mmHg recorded in an ambulatory care setting. Patients were outreached via telephone or approached at their Cone Health community pharmacy. Patients that underwent telephonic outreach were recruited from an electronic medical record report that listed recent patient ambulatory blood pressure reading data taken at a Cone Health clinic. A community pharmacist, pharmacy resident, or pharmacy student under the supervision of a pharmacist led the blood pressure monitoring encounter. The pharmacist or pharmacy student led the visit by asking questions related to medication adherence, adverse effects, and at-home blood pressure monitoring. Patients were counseled on the importance of blood pressure control in preventing cardiovascular events, non-pharmacological methods of blood pressure control, and how to properly monitor their blood pressure at home. The primary outcome was a mean change in systolic and diastolic blood pressure in the overall study population. Secondary objectives included percent of African Americans and general population with BP at goal (< 140/90 mmHg), adherence to blood pressure medications (assessed by proportion of days covered), and the number of social drivers of health at risk at time of outreach.
Results: 
Between August 1 and December 31, 2024, 70 patients were included in the study. Of this cohort, 59 patients (84.3%) had a post-encounter blood pressure (BP) reading recorded. Eight patients approached the pharmacy counter for BP screenings but only 2 patients were included in the study. The mean BP was 156/92 mmHg pre-encounter and 142/84 mmHg post-encounter, with a mean within-subject change in systolic blood pressure (SBP) of -12 .4 mmHg (95% CI –19.4 to –5.5; P< 0.001) and diastolic blood pressure (DBP) of –7.4 mmHg (95% CI –11.5 to –3.4; P < 0.001). Overall, achievement of target BP goal of < 140/90 mmHg occurred in 54.2% of patients post-intervention (OR 7.8; 95% CI 2.7-30.2; p<0.001). In a subgroup analysis, BP goal was achieved post-intervention in 26 of the 52 patients identifying as Black or African American and 6 of the 7 Non-Black patients; however, this difference did not reach statistical significance (P=0.11) at this sample size.  Similarly, a trend toward greater mean within-subject reductions was observed in Non-Black compared to Black or African American participants for both SBP (-17.9 vs -11.7; P=0.57 and DBP -8.6 vs 7.3; P =0.84), but these subgroup differences were not statistically significant.
Conclusion: 
Community pharmacist-led blood pressure monitoring encounters resulted in a decrease in average blood pressure. The disparity in achievement of controlled blood pressure persisted in our study, although this difference was not found to be statistically significant. This could be due to limited time and resources to address patients’ social determinants of health.