Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community: The Alberta Clinical Trial in Optimizing Hypertension (RxACTION).

BACKGROUND: Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving, and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. METHODS AND RESULTS: We designed a patient-level, randomized, controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines) through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age, 64 years; 49% male) were enrolled. Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg. The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group, an adjusted difference of 6.6±1.9 mm Hg (P=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% confidence interval, 1.17-4.15 in favor of the intervention). CONCLUSIONS: Pharmacist prescribing for patients with hypertension resulted in a clinically important and statistically significant reduction in BP. Policy makers should consider an expanded role for pharmacists, including prescribing, to address the burden of hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00878566.

Survey of Alberta hospital pharmacists' perspectives on additional prescribing authorization.

PURPOSE: The results of a survey to determine reasons for the slow adoption of prescribing authority by hospital pharmacists in the Canadian province of Alberta are presented. METHODS: A Web-based survey was conducted to elucidate pharmacist perspectives on additional prescribing authorization (APA), which permits independent prescribing by Alberta pharmacists who complete a peer-reviewed application process (at the time of the survey, only 52 hospital pharmacists had been granted APA). The survey elicited demographic data and practice characteristics and explored perspectives on APA and their influence on the decision to apply or not apply for APA. RESULTS: Approximately 500 pharmacists were invited to participate in the survey, and 314 (63%) responded and met the study inclusion criteria. The perceived relevancy and value of APA to respondents' practice activities and potential benefits such as increased efficiency appear to be important factors motivating pharmacists to apply for APA. A perception that the application process is too lengthy and concerns about potential drawbacks (e.g., increased liability risk, inability to fulfill patient follow-up and documentation requirements) appear to be strong influences on decisions to forgo pursuing APA. CONCLUSION: Results of a survey of hospital pharmacists in Alberta suggest that APA is adopted more often by pharmacists whose primary focus is ambulatory care, those with higher levels of education, and those with more colleagues who also have APA. The perceived relevancy and value of APA to practice activities and the potential for increased efficiency and job satisfaction appear to be strong influences on decisions to seek APA.

Improving hypertension management through pharmacist prescribing; the rural Alberta clinical trial in optimizing hypertension (Rural RxACTION): trial design and methods.

BACKGROUND: Patients with hypertension continue to have less than optimal blood pressure control, with nearly one in five Canadian adults having hypertension. Pharmacist prescribing is gaining favor as a potential clinically efficacious and cost-effective means to improve both access and quality of care. With Alberta being the first province in Canada to have independent prescribing by pharmacists, it offers a unique opportunity to evaluate outcomes in patients who are prescribed antihypertensive therapy by pharmacists. METHODS: The study is a randomized controlled trial of enhanced pharmacist care, with the unit of randomization being the patient. Participants will be randomized to enhanced pharmacist care (patient identification, assessment, education, close follow-up, and prescribing/titration of antihypertensive medications) or usual care. Participants are patients in rural Alberta with undiagnosed/uncontrolled blood pressure, as defined by the Canadian Hypertension Education Program. The primary outcome is the change in systolic blood pressure between baseline and 24 weeks in the enhanced-care versus usual-care arms. There are also three substudies running in conjunction with the project examining different remuneration models, investigating patient knowledge, and assessing health-resource utilization amongst patients in each group. DISCUSSION: To date, one-third of the required sample size has been recruited. There are 15 communities and 17 pharmacists actively screening, recruiting, and following patients. This study will provide high-level evidence regarding pharmacist prescribing. TRIAL REGISTRATION: Clinicaltrials.gov NCT00878566.