Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial

Abstract

Abstract Objective To determine the effects of a patient-centred intervention by community pharmacists on adherence to treatment for hypertension. Study design Randomised controlled trial. Method Randomisation was at pharmacy level. Pharmacists in the intervention group used a structured, brief questioning protocol to identify patients' medication-related problems and their information needs relating to hypertension and its treatment. Advice, information and referral to the general practitioner (GP) were provided by the pharmacist, based on patients' responses. Pharmacists in the control group provided usual care. The intervention was delivered three times at approximately two-month intervals. Blood pressure measurements were collected retrospectively from GP medical records. Patients completed feedback questionnaires at baseline and post-study. The questionnaire comprised a self-reported adherence measure and explored satisfaction with pharmaceutical services. Setting Twenty community pharmacy sites (11 intervention and nine controls) in one health authority area in England. Outcome measures Control of blood pressure; patient satisfaction with pharmaceutical services; self-reported adherence. Results In total, 180 patients (101 intervention and 79 control) from 43 general medical practices completed the trial. Patients whose blood pressure was uncontrolled prior to the study were more likely to become controlled in the intervention group (P<0.05). Most of the effect on self-reported adherence was seen after the first intervention. Patient satisfaction was high prior to the study and was increased in the intervention group after the study. The increase was statistically significant for five items relating to communication between pharmacist and patient. Conclusion A simple intervention delivered by community pharmacists produces positive effects on blood pressure control, self-reported adherence and on patient satisfaction with pharmaceutical services.