The Permanente journal · 2025
Evaluating the Impact of "On the Spot": A Remote Pharmacy Hypertension Consult Service.
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Bethune Briana, Coates Jamie, Yates Naomi
Аннотация
INTRODUCTION: Pharmacist intervention can improve blood pressure (BP) control during scheduled pharmacy appointments; however, remote pharmacist impact during in-person nurse visits remains unclear. This study evaluated whether real-time remote consultations with clinical pharmacy specialists (CPSs) during nurse visits improve BP outcomes for patients.
METHODS: This retrospective cohort study included adult patients with hypertension and a repeat BP of 140-179/90-109 mmHg during a nurse visit from November 2023 to August 2024. Exclusion criteria included pregnancy, hospice/palliative care, and estimated glomerular filtration rate < 30 mL/min/1.73 m². The intervention group received immediate CPS consultation via secure chat; the control group received usual care from the "Doctor of the Day." Outcomes included time to BP goal (≤ 140/90 mmHg), medication optimization, BP change from baseline, BP goal attainment, and enrollment in remote BP monitoring (RBPM).
RESULTS: Among 1726 patients (1466 control; 260 intervention), time to BP control was similar between groups (31.93 vs 31.21 days, respectively). The intervention group had significantly higher rates of medication optimization (35.5% vs 62.3%) and RBPM enrollment (6.6% vs 63.1%). BP goal attainment (87.1% vs 88.2%) and BP reductions were comparable between control and intervention groups (systolic: -23.06 vs -24.91 mmHg; diastolic: -9.76 vs -8.27 mmHg, respectively).
DISCUSSION: The integration of remote CPS consultation into nurse visit appointments demonstrated higher rates of medication optimization and RBPM enrollment while providing similar BP control outcomes as compared to usual care.
CONCLUSION: The remote pharmacy hypertension consult service demonstrated a substantial impact by transforming ambulatory care practice and expanding access to care through use of remote technology.
METHODS: This retrospective cohort study included adult patients with hypertension and a repeat BP of 140-179/90-109 mmHg during a nurse visit from November 2023 to August 2024. Exclusion criteria included pregnancy, hospice/palliative care, and estimated glomerular filtration rate < 30 mL/min/1.73 m². The intervention group received immediate CPS consultation via secure chat; the control group received usual care from the "Doctor of the Day." Outcomes included time to BP goal (≤ 140/90 mmHg), medication optimization, BP change from baseline, BP goal attainment, and enrollment in remote BP monitoring (RBPM).
RESULTS: Among 1726 patients (1466 control; 260 intervention), time to BP control was similar between groups (31.93 vs 31.21 days, respectively). The intervention group had significantly higher rates of medication optimization (35.5% vs 62.3%) and RBPM enrollment (6.6% vs 63.1%). BP goal attainment (87.1% vs 88.2%) and BP reductions were comparable between control and intervention groups (systolic: -23.06 vs -24.91 mmHg; diastolic: -9.76 vs -8.27 mmHg, respectively).
DISCUSSION: The integration of remote CPS consultation into nurse visit appointments demonstrated higher rates of medication optimization and RBPM enrollment while providing similar BP control outcomes as compared to usual care.
CONCLUSION: The remote pharmacy hypertension consult service demonstrated a substantial impact by transforming ambulatory care practice and expanding access to care through use of remote technology.