2025 Southeastern Residency Conference

Title: Optimization of Pharmacist Interventions for a Health Equity Initiative to Improve Hypertension Control in African American Patients
Authors: Katie Sfirlea, Rachel Shelley, Luke Van Ausdall, Madison Yates
Objective: Describe the optimization of pharmacist interventions for a health equity initiative to improve hypertension control in African American patients
Self Assessment Question: What outcomes occurred as a result of the optimization of pharmacist interventions for African American hypertension control?
Background: The disparity between hypertension control in African American patients compared to White patients is a major health equity concern in the United States. At Cone Health, baseline data indicated a 6% gap in hypertension control between African American and White patients. From October 2022 to September 2023, implementation of a systemwide health equity goal resulted in improvement in African American hypertension control for patients seen by Cone Health primary care providers. To remain committed to health equity, beginning in October 2023 a new systemwide goal was created to obtain hypertension control for 71.4% of African American patients seen by any Cone Health provider. A previous project utilized a pharmacist-led initiative where all African American patients with uncontrolled hypertension at Cone Health Community Health and Wellness Center (CHWC), an internal medicine clinic, were referred to the embedded Clinical Pharmacist Practitioner (CPP) for medication management. In 45% of the CPP visits no medication changes were made due to the patient’s non-adherence to antihypertensives prior to the visit or being out of refills. A nurse blood pressure (BP) visit referral was added to the protocol to allow the CPP to focus on patients requiring more complex medication management. The purpose of this project is to assess hypertension control in African American patients prior to implementation of the new systemwide health equity goal (pre-intervention) as compared to post-intervention.
Methods: This single center, retrospective, IRB-reviewed and exempt, cohort study included African American patients initially seen by the CPP at CHWC for hypertension from October 1, 2023, to August 31, 2024, with follow up visits until September 30, 2024. Exclusion criteria included end-stage renal disease, dialysis, renal transplant, pregnancy, hospice, or palliative care. The primary outcome was the proportion of African American patients seen at CHWC with hypertension control pre-intervention as compared to post-intervention. Hypertension control was defined as BP <140/90 mm Hg at the last ambulatory visit during the study period. Secondary outcomes include patients seen by the CPP with hypertension control (baseline, last CPP visit, and end of study), average change in blood pressure, number of nurse and CPP visits, adherence to CPP referral protocol, and type of medication adjustments made by the CPP. Chi-square and descriptive statistics were used to analyze the data as appropriate.
Results: During this study, 72.1% (n=881) of African American patients seen at CHWC for hypertension achieved hypertension control post-intervention as compared to 62.3% (n=716) pre-intervention for a risk ratio 1.16, 95% CI (1.09-1.23), p<0.001. Of the 119 patients seen by the CPP, 73.1% achieved hypertension control by their last CPP visit. Patients seen by the CPP had an average decrease of 17 mm Hg in systolic blood pressure and 7 mm Hg in diastolic blood pressure. The referral protocol was followed for 70.5% of patients with only 17 patients having a nurse BP visit. The average number of CPP visits per patient overall was 1.76 and 1.57 for patients with controlled hypertension. During the study, 10.1% (n=12) of patients were lost to follow up.
Conclusions: African American hypertension control at CHWC was significantly improved post-intervention as compared to pre-intervention despite low utilization of nurse BP check visits. These results are consistent with a previous pharmacy resident project at CHWC that demonstrated significant improvements in African American hypertension control amongst patients managed by the CPP. Based on these results we will continue to optimize implementation of the nurse BP visit referral protocol and evaluate the feasibility of continued targeted hypertension follow up after hypertension control is achieved.