Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists

Mary Sue Beran, Stephen E. Asche, Anna R. Bergdall, Benjamin Crabtree, Beverly B. Green, Sarah E. Groen, Krissa J. Klotzle, Ryan D. Michels, Rachel A. Nyboer, Patrick J. O'Connor, Pamala A. Pawloski, Daniel J. Rehrauer, Jo Ann M. Sperl-Hillen, Nicole K. Trower, Karen L. Margolis

Research output: Contribution to journalArticle

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Abstract

Objectives: The Hyperlink trial tested a 12-month intervention of home blood pressure (BP) telemonitoring with pharmacist case management in adults with uncontrolled hypertension. The intervention resulted in improved BP control compared with usual care at both 6 (72% vs. 45%; P < 0.001) and 12 months (71% vs. 53%; P = 0.005). We sought to investigate factors contributing to intervention success. Design: Mixed-methods analysis of process of care data, patient focus groups, and pharmacist interviews. Participants: Data from 228 intervention patients were examined from the original 450 patients randomly assigned from 16 primary care clinics. Five patient focus groups and 4 pharmacist interviews were conducted to ascertain the patient and pharmacist perspective. Focus group and interview data were coded, and themes relevant to pharmacists were identified. Outcome measures: Home BP readings of less than 135/85 mm Hg and patient focus group and pharmacist interview themes. Results: Mean BP at the intake visit was 148/85 mm Hg. Antihypertensive medications were adjusted in 10% of patients at the initial in-person visit, 33% at phone visit 1, 36% at phone visit 2, and 19% at phone visit 3. Thereafter, medication changes declined. The mean home BP for patients at the first phone visit was 136/80 mm Hg, 126/74 mm Hg at 3 months, and 123/73 mm Hg at 5 months, with little change thereafter. Key components of success from patient and pharmacist interviews included a strong patient–pharmacist relationship, individualized treatment plans, and frequent phone contact with the pharmacist. Conclusion: Frequent adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP. Our results suggest that an intensive telephone-based intervention with the key components of medication adjustments, a strong patient and pharmacist relationship, and individualized treatment plans can achieve BP control in only 3 months in many patients with uncontrolled hypertension.

Original languageEnglish (US)
Pages (from-to)614-621
Number of pages8
JournalJournal of the American Pharmacists Association
Volume58
Issue number6
DOIs
StatePublished - Nov 1 2018

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Medication Therapy Management
Blood pressure
Pharmacists
Blood Pressure
Focus Groups
Interviews
Pressure control
Antihypertensive Agents
Hypertension
Telephone
Case Management
Reading
Primary Health Care
Patient Care
Therapeutics

All Science Journal Classification (ASJC) codes

  • Pharmacology (nursing)
  • Pharmacy
  • Pharmacology

Cite this

Beran, Mary Sue ; Asche, Stephen E. ; Bergdall, Anna R. ; Crabtree, Benjamin ; Green, Beverly B. ; Groen, Sarah E. ; Klotzle, Krissa J. ; Michels, Ryan D. ; Nyboer, Rachel A. ; O'Connor, Patrick J. ; Pawloski, Pamala A. ; Rehrauer, Daniel J. ; Sperl-Hillen, Jo Ann M. ; Trower, Nicole K. ; Margolis, Karen L. / Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists. In: Journal of the American Pharmacists Association. 2018 ; Vol. 58, No. 6. pp. 614-621.
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abstract = "Objectives: The Hyperlink trial tested a 12-month intervention of home blood pressure (BP) telemonitoring with pharmacist case management in adults with uncontrolled hypertension. The intervention resulted in improved BP control compared with usual care at both 6 (72{\%} vs. 45{\%}; P < 0.001) and 12 months (71{\%} vs. 53{\%}; P = 0.005). We sought to investigate factors contributing to intervention success. Design: Mixed-methods analysis of process of care data, patient focus groups, and pharmacist interviews. Participants: Data from 228 intervention patients were examined from the original 450 patients randomly assigned from 16 primary care clinics. Five patient focus groups and 4 pharmacist interviews were conducted to ascertain the patient and pharmacist perspective. Focus group and interview data were coded, and themes relevant to pharmacists were identified. Outcome measures: Home BP readings of less than 135/85 mm Hg and patient focus group and pharmacist interview themes. Results: Mean BP at the intake visit was 148/85 mm Hg. Antihypertensive medications were adjusted in 10{\%} of patients at the initial in-person visit, 33{\%} at phone visit 1, 36{\%} at phone visit 2, and 19{\%} at phone visit 3. Thereafter, medication changes declined. The mean home BP for patients at the first phone visit was 136/80 mm Hg, 126/74 mm Hg at 3 months, and 123/73 mm Hg at 5 months, with little change thereafter. Key components of success from patient and pharmacist interviews included a strong patient–pharmacist relationship, individualized treatment plans, and frequent phone contact with the pharmacist. Conclusion: Frequent adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP. Our results suggest that an intensive telephone-based intervention with the key components of medication adjustments, a strong patient and pharmacist relationship, and individualized treatment plans can achieve BP control in only 3 months in many patients with uncontrolled hypertension.",
author = "Beran, {Mary Sue} and Asche, {Stephen E.} and Bergdall, {Anna R.} and Benjamin Crabtree and Green, {Beverly B.} and Groen, {Sarah E.} and Klotzle, {Krissa J.} and Michels, {Ryan D.} and Nyboer, {Rachel A.} and O'Connor, {Patrick J.} and Pawloski, {Pamala A.} and Rehrauer, {Daniel J.} and Sperl-Hillen, {Jo Ann M.} and Trower, {Nicole K.} and Margolis, {Karen L.}",
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Beran, MS, Asche, SE, Bergdall, AR, Crabtree, B, Green, BB, Groen, SE, Klotzle, KJ, Michels, RD, Nyboer, RA, O'Connor, PJ, Pawloski, PA, Rehrauer, DJ, Sperl-Hillen, JAM, Trower, NK & Margolis, KL 2018, 'Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists', Journal of the American Pharmacists Association, vol. 58, no. 6, pp. 614-621. https://doi.org/10.1016/j.japh.2018.07.001

Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists. / Beran, Mary Sue; Asche, Stephen E.; Bergdall, Anna R.; Crabtree, Benjamin; Green, Beverly B.; Groen, Sarah E.; Klotzle, Krissa J.; Michels, Ryan D.; Nyboer, Rachel A.; O'Connor, Patrick J.; Pawloski, Pamala A.; Rehrauer, Daniel J.; Sperl-Hillen, Jo Ann M.; Trower, Nicole K.; Margolis, Karen L.

In: Journal of the American Pharmacists Association, Vol. 58, No. 6, 01.11.2018, p. 614-621.

Research output: Contribution to journalArticle

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T1 - Key components of success in a randomized trial of blood pressure telemonitoring with medication therapy management pharmacists

AU - Beran, Mary Sue

AU - Asche, Stephen E.

AU - Bergdall, Anna R.

AU - Crabtree, Benjamin

AU - Green, Beverly B.

AU - Groen, Sarah E.

AU - Klotzle, Krissa J.

AU - Michels, Ryan D.

AU - Nyboer, Rachel A.

AU - O'Connor, Patrick J.

AU - Pawloski, Pamala A.

AU - Rehrauer, Daniel J.

AU - Sperl-Hillen, Jo Ann M.

AU - Trower, Nicole K.

AU - Margolis, Karen L.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Objectives: The Hyperlink trial tested a 12-month intervention of home blood pressure (BP) telemonitoring with pharmacist case management in adults with uncontrolled hypertension. The intervention resulted in improved BP control compared with usual care at both 6 (72% vs. 45%; P < 0.001) and 12 months (71% vs. 53%; P = 0.005). We sought to investigate factors contributing to intervention success. Design: Mixed-methods analysis of process of care data, patient focus groups, and pharmacist interviews. Participants: Data from 228 intervention patients were examined from the original 450 patients randomly assigned from 16 primary care clinics. Five patient focus groups and 4 pharmacist interviews were conducted to ascertain the patient and pharmacist perspective. Focus group and interview data were coded, and themes relevant to pharmacists were identified. Outcome measures: Home BP readings of less than 135/85 mm Hg and patient focus group and pharmacist interview themes. Results: Mean BP at the intake visit was 148/85 mm Hg. Antihypertensive medications were adjusted in 10% of patients at the initial in-person visit, 33% at phone visit 1, 36% at phone visit 2, and 19% at phone visit 3. Thereafter, medication changes declined. The mean home BP for patients at the first phone visit was 136/80 mm Hg, 126/74 mm Hg at 3 months, and 123/73 mm Hg at 5 months, with little change thereafter. Key components of success from patient and pharmacist interviews included a strong patient–pharmacist relationship, individualized treatment plans, and frequent phone contact with the pharmacist. Conclusion: Frequent adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP. Our results suggest that an intensive telephone-based intervention with the key components of medication adjustments, a strong patient and pharmacist relationship, and individualized treatment plans can achieve BP control in only 3 months in many patients with uncontrolled hypertension.

AB - Objectives: The Hyperlink trial tested a 12-month intervention of home blood pressure (BP) telemonitoring with pharmacist case management in adults with uncontrolled hypertension. The intervention resulted in improved BP control compared with usual care at both 6 (72% vs. 45%; P < 0.001) and 12 months (71% vs. 53%; P = 0.005). We sought to investigate factors contributing to intervention success. Design: Mixed-methods analysis of process of care data, patient focus groups, and pharmacist interviews. Participants: Data from 228 intervention patients were examined from the original 450 patients randomly assigned from 16 primary care clinics. Five patient focus groups and 4 pharmacist interviews were conducted to ascertain the patient and pharmacist perspective. Focus group and interview data were coded, and themes relevant to pharmacists were identified. Outcome measures: Home BP readings of less than 135/85 mm Hg and patient focus group and pharmacist interview themes. Results: Mean BP at the intake visit was 148/85 mm Hg. Antihypertensive medications were adjusted in 10% of patients at the initial in-person visit, 33% at phone visit 1, 36% at phone visit 2, and 19% at phone visit 3. Thereafter, medication changes declined. The mean home BP for patients at the first phone visit was 136/80 mm Hg, 126/74 mm Hg at 3 months, and 123/73 mm Hg at 5 months, with little change thereafter. Key components of success from patient and pharmacist interviews included a strong patient–pharmacist relationship, individualized treatment plans, and frequent phone contact with the pharmacist. Conclusion: Frequent adjustments to the antihypertensive treatment regimen based on home BP telemonitoring resulted in rapid lowering of BP. Our results suggest that an intensive telephone-based intervention with the key components of medication adjustments, a strong patient and pharmacist relationship, and individualized treatment plans can achieve BP control in only 3 months in many patients with uncontrolled hypertension.

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