Provider perspectives on self-management of hypertension: a survey of perceptions and clinical pharmacist utilization.

BACKGROUND

Previous studies have shown pharmacist-based interventions improve blood pressure (BP) control in individuals with hypertension. Here, we evaluated provider attitudes towards the utilization of at-home self-monitoring of BP, clinical pharmacist support, and pharmacist-guided medication self-titration in the management of hypertension.

METHODS

This was a quality improvement project at the University of Iowa Hospitals and Clinics and the Iowa City VA Health Care System. We conducted an electronic survey to determine the attitudes of providers regarding various strategies in the management of hypertension. We surveyed primary care providers, internal medicine residents, nephrologists, cardiologists, nephrology and cardiology fellows, and nurse practitioners. Continuous data were summarized with medians and interquartile ranges and compared across strata using Wilcoxon rank sum tests. Categorical variables were summarized as counts and percentages and compared using Fisher’s exact tests. Analyses were stratified by training status, specialty, and clinical setting. Open-ended comments were analyzed for overarching themes and positive, negative, or neutral sentiment.

RESULTS

Of the 413 surveyed providers, 153 completed the survey, the majority of whom (78%) identified their role as clinicians. We observed high confidence in the diagnosis and treatment of hypertension among all surveyed groups. 91% of providers (N = 132) reported that at least once per week or more frequently, their decision to up-titrate BP medications was influenced by a patient’s home BP readings. Nearly half of those surveyed indicated that they had never referred their patients to a clinical pharmacist for BP medication management and a third reported doing so rarely (once or twice a month or less). Respondents, however, agreed that clinical pharmacists could support clinical decision-making for managing BP medications (68%), reduce the burden on providers (68%), and improve the safety of HTN treatment plans (72%).

CONCLUSIONS

Clinical pharmacists are underutilized in clinical practice although providers expressed favorable perception of clinical pharmacists’ roles in the management of hypertension. Considering the evidence that pharmacist-based management of high BP improves BP control, interventions are needed to improve pharmacist utilization in the maagement of hypertension.