June 5, 2013
Web-Based Pharmacist Care Significantly Improves BP Control

Seattle—Using pharmacist team care delivered through a Web site doubled the likelihood that patients with severe hypertension had their conditions under control a year later, according to a new report.

The research letter, published recently in JAMA Internal Medicine, noted that, while “strong evidence” suggests that team-based hypertension care can be highly effective, few studies have determined whether reductions in blood pressure (BP) are sustained at the end of an intervention.

For the Electronic Communications and Home Blood Pressure Trial (e-BP), 778 Group Health patients with uncontrolled BP were registered to use an existing patient Web site, including secure e-mail and an electronic health record shared with patients, then randomly assigned to one of three interventions.

The first group received usual care from a physicians’ office only, the second group employed home BP monitoring and Web site training, while the third group used home BP monitoring and Web site training but also received pharmacist team care via the Web site.

With 618 participants remaining at the end of the year-long intervention, 48% of those receiving usual care, 52% of those who self-monitored and 60% of those with online communication access to a pharmacy team sustained moderate blood pressure levels, defined as under 140/90. The differences were even greater among those who began with higher BP levels.

“BP benefits occurred mainly in those with more severe hypertension at baseline, with web-based pharmacist team patients almost twice as likely to have controlled BP,” the authors write.

They note that, in patients with a BP of 160 mm Hg or higher at baseline, BP control was 56% in the pharmacist group compared to 34% in participants receiving usual care and 23% of those who self-monitored.

“At the end of the 1-year intervention, [patients in the third group] were twice as likely to have controlled BP,” according to researchers, who added, “Our objective was to determine if BP reductions were sustained after the intervention ended.”

They noted that Web-delivered pharmacy team care resulted in improved BP control 6 to 18 months after the completion of interventions.

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