Bozeman, MT—Allowing pharmacists to have broader scopes of practice can pay off in better community healthcare, according to a new conference presentation discussing an effort to improve hypertension (HTN) control in Montana.

Background information in the study presented at the American Heart Association Hypertension 2022 Scientific Sessions points out that Bozeman Health (BH) Primary Care provides care to 8,000 patients with a diagnosis of HTN. In 2019, however, fewer than one-half of the patients had their high blood pressure (BP) controlled.

That prompted the creation of a new program made possible by the State of Montana Board of Pharmacy granting pharmacists the ability to have collaborative practice agreements with other providers. The authors explained that the policy “allows the pharmacist to act as an intermediary to the provider and a ‘safety net’ for the nurses working off protocol. Utilizing evidence-based medication protocols, registered nurses (RNs) with clinical pharmacy collaboration, began treating HTN patients utilizing motivational interviewing, shared decision making, lifestyle modification, risk assessment tools, medication titration and regular follow-up. The program is initiated with a primary care provider (PCP) referral.”

The RN-Pharmacist–led HTN Clinic was implemented in January 2019 after a 3-month pilot program that showed 90% (35 of 39) of enrolled patients achieved BP goals within 9 or fewer weeks.

As part of the program, ambulatory care RNs completed a 12-week intensive educational program on HTN. They then managed patient appointments (including telemedicine appointments), charted medications, and worked off of medication protocol algorithms. The nurses sent office notes were sent to the pharmacist to sign prescriptions and then to the PCP for general information. “Patients were seen in follow-up every 2-4 weeks with the HTN RN until their BP and personal goals were met,” according to the study.

The project’s primary objective was to have 75% of patients referred to the HTN clinic at goal within 12 weeks. Secondary outcomes included secondary cause risk assessment, a decrease in BMI, and high patient satisfaction scores.

Of the 321 patients receiving the intervention, 74% were at BP goal within 12 weeks as of the time of the convention in San Diego. The researchers report that the average decrease in systolic BP was -8.4 mmHg and -5.5 mmHg for diastolic BP.

The researchers added that the patients, who had an average net decrease of 0.12 kg/m2 in BMI upon graduation from the program, said they were very satisfied, with a score of 4.8 out of 5.

“The RN-Pharmacist Led HTN Clinic is an innovative, collaborative, multidisciplinary approach to hypertension management that allows care team members to practice at the top of licensure while improving HTN outcomes and achieving high patient satisfaction,” the authors concluded.

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