Impact of Direct Clinical Pharmacist Intervention on Achievement of Blood Pressure Control at a Federally Qualified Health Center Within a Medically Underserved Area.

Abstract

Previous publications have demonstrated the benefits of pharmacist involvement in hypertension management, including in rural health care settings. Unlike many of the previous studies that evaluated pharmacist interventions occurring in collaboration with physicians, this study uniquely assessed the impact of pharmacist-led interventions under a collaborative practice agreement (CPA) on hypertension outcomes in a rural, medically underserved federally qualified health center (FQHC) in the southeastern U.S. To evaluate the effectiveness of direct pharmacist intervention under a CPA compared to physician-only standard care in achieving blood pressure (BP) control. Secondary outcomes included all-cause hospitalization rates and adherence to antihypertensive medications. This retrospective, single-center observational study included adult patients with hypertension seen by either a clinical pharmacist or a primary care provider over a 3-month period. Primary outcomes were the proportion of patients reaching target systolic and/or diastolic BP and the median time in days to control. Secondary outcomes included all-cause hospitalizations and changes in antihypertensive medication adherence, measured by proportion of days covered (PDC). Among 159 patients, those managed by pharmacists achieved significantly faster BP control (SBP: 49 days vs 182 days, <i>P</i> < .0001; DBP: 146 days vs 160 days, <i>P</i> = .0061). Combined SBP/DBP control was also achieved more quickly (160 days, <i>P</i> < .0001), despite higher initial BP levels. Notably, 0% of patients in the pharmacist group were hospitalized, compared to 10% in the physician-only group (<i>P</i> = .0065). Medication adherence improved, with average PDC rising from 72.5% to 80.2%, and 70.4% of patients reaching ≥80% adherence by study end. Pharmacist-led hypertension management under a CPA significantly improves BP control, time to goal, medication adherence, and reduces hospitalizations compared to physician-only care in a rural, underserved FQHC setting.