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The pharmaceutical care of patients with hypertension: an examination of service models in primary care in the US


Background: In the UK, the delivery of health care in cardiovascular disease is guided by 'national service frameworks', which are a source of standards of practice and evidence that help to define and aid the implementation of service models capable of responding to public health goals. The revised British Hypertension Society guidelines reflect a lower target blood pressure consistent with those recommended in the US and by the WHO. The lowering of the target for the control of blood pressure has increased the estimated proportion of treated patients with inadequate control in the UK from 37% to 72%.

Objective: To identify the requirements for the provision of a pharmacy service that supports hypertension monitoring, and to gain insights into how such a service might be delivered as part of a wider provision of pharmaceutical care in the UK.

Method: Two pharmacists followed a structured programme of observation involving three centres in the United States (Minnesota, Colorado and Iowa). Twelve clinical settings were observed, and the pharmacists who provided the services were also the subjects of documented interviews. The settings offered different models of pharmaceutical care from which issues relevant to the international development of such services were identified.

Findings: Differences noted between the service models observed included; physical environment of the community pharmacy, the use and type of documentation, methods of blood pressure measurement, extent of monitoring and follow‐up, inter‐professional communication and service orientation in terms of the provision of comprehensive pharmaceutical care to patients or specific disease management.

Conclusion: If clearly defined operational models of pharmaceutical care practice in the primary care setting are to form part of a national public health strategy in the UK, they must also be capable of responding to local opportunities and patients' needs. Future development of models and services must be patient‐centred and more widely informed by the range of practice experience gained elsewhere.

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  1. 1

    White Paper. Saving Lives: Our Healthier Nation. HMSO 1999; London.

  2. 2

    Department of Health. National Service Framework for Coronary Heart Disease. London, 2000.

  3. 3

    Joint National Committee. The sixth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC VI). Arch Intern Med 1997;157: 2413-46.

    Google Scholar 

  4. 4

    Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999;11:151-83.

    Google Scholar 

  5. 5

    Health Survey for England: Cardiovascular Disease '98. HMSO; London 1999.

  6. 6

    Carter B, Barnette D, Chrischilles E, Mazzoti G, Asali Z. Evaluation of hypertensive patients after care provided by community pharmacists in a rural setting. Pharmacotherapy 1997;17:1274-85.

    Google Scholar 

  7. 7

    Park J, Kelly P, Carter B, Burgess P. Comprehensive phamaceutical care in the chain setting. J Am Pharm Assoc (Wash) 1996;NS36:443-51.

    Google Scholar 

  8. 8

    Royal Pharmaceutical Society of Great Britain. Medicines, ethics and practice.A guide for pharmacists. London: July 2000.

  9. 9

    Blenkinsopp A, Phelan M, Bourne J, Frischer M. What is the effect on patient satisfaction of an intervention by community pharmacists for patients with hypertension Pharm J 1999;263 (research suppl.):R17.

    Google Scholar 

  10. 10

    Blenkinsopp A, Phelan M, Bourne J, Frischer M, Dakhil N. Can control of blood pressure be improved by an intervention by community pharmacists? Pharm J 1999;263 (research suppl.):Rl6.

    Google Scholar 

  11. 11

    Cunningham I, McKenzie V, Cunnigham G. Encouraging rational prescribing of antihypertensive combinations in primary care through formulary and prescribing protocol development. Pharm J 2000;265 (research suppl.):RI4.

    Google Scholar 

  12. 12

    O'Donoghue T, Blenkilisopp A. Concordance and compliance among patients hypertension: a qualitative study. Pharm J 1999;263 (research suppl.):R8.

    Google Scholar 

  13. 13

    Thomas J, Walker R. Impact of a practice pharmacist on patients taking antihypertensive medication. Pharm J 2000;265 (research suppl.):R5.

    Google Scholar 

  14. 14

    Canaday B, Yarborough P. Documenting pharmaceutical care: creating a standard. Ann Pharmacother 1994;28:1292-6.

    Google Scholar 

  15. 15

    Cipolle R, Strand L, Morley P. Computer programs for pharmaceutical care. Pharmaceutical care practices. 1st ed. New York: McGraw Hill, 1998:198-204.

    Google Scholar 

  16. 16

    Cipolle R, Strand L, Morley P. Identifying, resolving, and preventing drug therapy problems: the pharmacist's responsibilty. In: Pharmaceutical Care Practice. New York; McGraw Hill, 1998:73-120.

    Google Scholar 

  17. 17

    Glover C. Call it medicines management not pharmaceutical care. Pharm J 2000;265:808.

    Google Scholar 

  18. 18

    Weed L. Medical records that guide and teach. N Engl J Med 1968;278:652-7 concl.

    Google Scholar 

  19. 19

    Weed L. Medical records that guide and teach. N Engl J Med 1968;278:593-600.

    Google Scholar 

  20. 20

    O'Brien E, Waeber B, Parati G, Staessen J, Myers M, on behalf of the European Society of Hypertension Working Group on Blood Pressure monitoring. Blood pressure monitoring devices: recommendations of the European Society of Hypertension. BMJ 2001;322:531-536.

    Google Scholar 

  21. 21

    Yarows S, Julius S, Pickering T. Home blood pressure monitoring. Arch Intern Med2000;160:1251-7.

    Google Scholar 

  22. 22

    O'Brien E. Automated blood pressure measurement: state of the market in 1998 and the need for an international validation protocol for blood pressure measuring devices. Blood Pressure Monitoring 1998;3:205-11.

    Google Scholar 

  23. 23

    Granas A, Bates I. The effect of pharmaceutical reviev of repeat prescriptions in general practice. Int J Pharm Pract 1999; 7:264-75.

    Google Scholar 

  24. 24

    Goldstein R, Hulme H, Willits J. RevieNving repeat prescribing-general practitioners and community pharmacists working together. Int J Pharm Pract 1998;6:60-6.

    Google Scholar 

  25. 25

    Williams S, Bond C, Menzies C. A pharmaceutical needs assessment in a primary care setting. Br J Gen Pract 2000; 50:95-9.

    Google Scholar 

  26. 26

    Klepping G. Medication review in elderly care homes. Primary Care Pharmacy 2000;1:105-8.

    Google Scholar 

  27. 27

    Hawksworth G, Corlett A, Wright D, Chrystyn H. Clinical pharmacy interventions by community pharmacists during the dispensing process, Br J Clin Pharmacol 1999;47:695-700

    Google Scholar 

  28. 28

    Schneider J, Barber N. Provision of a domiciliary service by community pharmacists. Int J Pharm Pract 1996;4:19-24.

    Google Scholar 

  29. 29

    MacKinnon M. Appendix VII-Template for a locally produced patient-held record card. Providing diabetes care in General Practice-A practical guide for the Primary Care Team. 3rd ed. London: Class Publishing, 1998:269-80.

    Google Scholar 

  30. 30

    Drummond N, Abdalla M, Beattie J, et al. Effectiveness of self monitoring of peak flow in patients with asthma. BMJ 1994;308:564-7.

    Google Scholar 

  31. 31

    Jones K, Mullee M, Middleton M, Chapman E, Holgate S. Peak flow based asthma self management: a randomised controlled study in general practice. British Thoracic Society Research Committee. Thorax 1995;50:851-7.

    Google Scholar 

  32. 32

    Jones A, Pill R, Adams S. Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ 2000;321:1507-10.

    Google Scholar 

  33. 33

    Department of Health. The NHS plan. A plan for investment. A plan for reform. London: Stationery Office london, 2000.

    Google Scholar 

  34. 34

    Wallis E, Ramsay L, Ul Haq I, et al. Coronary and cardiovascular risk estimation for primary prevention: validation of a new Sheffield table in the 1995 Scottish health survey population. BMJ 2000;320:671-6.

    Google Scholar 

  35. 35

    Scottish Intercollegiate Guidelines Network (SIGN). Lipids and the primary prevention of coronary heart disease. Edinburgh,1999.

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McAnaw, J., Hudson, S. & McGregor, A. The pharmaceutical care of patients with hypertension: an examination of service models in primary care in the US. Pharm World Sci 23, 189–194 (2001).

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  • Blood pressure monitoring
  • Cardiovascular disease
  • Community pharmacy
  • Documentation
  • Hypertension
  • Pharmaceutical care