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Hypertension: HELP
Articles by Barry L. Carter
Based on 41 articles published since 2010
(Why 41 articles?)
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Between 2010 and 2020, B. L. Carter wrote the following 41 articles about Hypertension.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). 2014

James, Paul A / Oparil, Suzanne / Carter, Barry L / Cushman, William C / Dennison-Himmelfarb, Cheryl / Handler, Joel / Lackland, Daniel T / LeFevre, Michael L / MacKenzie, Thomas D / Ogedegbe, Olugbenga / Smith, Sidney C / Svetkey, Laura P / Taler, Sandra J / Townsend, Raymond R / Wright, Jackson T / Narva, Andrew S / Ortiz, Eduardo. ·University of Iowa, Iowa City. · University of Alabama at Birmingham School of Medicine. · Memphis Veterans Affairs Medical Center and the University of Tennessee, Memphis. · Johns Hopkins University School of Nursing, Baltimore, Maryland. · Kaiser Permanente, Anaheim, California. · Medical University of South Carolina, Charleston. · University of Missouri, Columbia. · Denver Health and Hospital Authority and the University of Colorado School of Medicine, Denver. · New York University School of Medicine, New York, New York. · University of North Carolina at Chapel Hill. · Duke University, Durham, North Carolina. · Mayo Clinic College of Medicine, Rochester, Minnesota. · University of Pennsylvania, Philadelphia. · Case Western Reserve University, Cleveland, Ohio. · National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. · at the time of the project,National Heart, Lung, and Blood Institute, Bethesda, Maryland17currently with ProVation Medical, Wolters Kluwer Health, Minneapolis, Minnesota. ·JAMA · Pubmed #24352797.

ABSTRACT: Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

2 Guideline Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. 2014

Weber, Michael A / Schiffrin, Ernesto L / White, William B / Mann, Samuel / Lindholm, Lars H / Kenerson, John G / Flack, John M / Carter, Barry L / Materson, Barry J / Ram, C Venkata S / Cohen, Debbie L / Cadet, Jean-Claude / Jean-Charles, Roger R / Taler, Sandra / Kountz, David / Townsend, Raymond R / Chalmers, John / Ramirez, Agustin J / Bakris, George L / Wang, Jiguang / Schutte, Aletta E / Bisognano, John D / Touyz, Rhian M / Sica, Dominic / Harrap, Stephen B. ·State University of New York, Downstate College of Medicine, Brooklyn, NY. ·J Clin Hypertens (Greenwich) · Pubmed #24341872.

ABSTRACT: -- No abstract --

3 Guideline Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. 2014

Weber, Michael A / Schiffrin, Ernesto L / White, William B / Mann, Samuel / Lindholm, Lars H / Kenerson, John G / Flack, John M / Carter, Barry L / Materson, Barry J / Ram, C Venkata S / Cohen, Debbie L / Cadet, Jean-Claude / Jean-Charles, Roger R / Taler, Sandra / Kountz, David / Townsend, Raymond / Chalmers, John / Ramirez, Agustin J / Bakris, George L / Wang, Jiguang / Schutte, Aletta E / Bisognano, John D / Touyz, Rhian M / Sica, Dominic / Harrap, Stephen B. ·aState University of New York, Downstate College of Medicine, Brooklyn, New York, USA bDepartment of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Canada cCalhoun Cardiology Center, University of Connecticut, Farmington, Connecticut dDepartment of Medicine, Weil Cornell College of Medicine, New York, New York, USA eDepartment of Public Health and Clinical Medicine, Umea University, Umea, Sweden fCardiovascular Associates, Virginia Beach, Virginia gDepartment of Medicine, Wayne State University, Detroit, Michigan hDepartment of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa iDepartment of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA jMediCiti Institutions, Hyderabad, India kDepartment of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA lState University School of Medicine mHypertension Center of Haiti, Port-au-Prince, Haiti nDepartment of Medicine, Mayo Clinic, Rochester, Minnesota oJersey Shore University Medical Center, Neptune, New Jersey pHypertension Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA qGeorge Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia rArterial Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina sASH Comprehensive Hypertension Center, University of Chicago Medicine, Chicago, Illinois, USA tThe Shanghai Institute of Hypertension, Shanghai Jiaotong University School of Medicine, Shanghai, China uHypertension in Africa Research Team, North West University, Potchefstroom, South Africa vDepartment of Medicine, University of Rochester Medical Center, Rochester, New York, USA wInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Lanarkshire, UK xVirginia Commonwealth University, Richmond, Virginia, USA yDepartment of Physiology, University of Melbourne, Melbourne, Australia. ·J Hypertens · Pubmed #24270181.

ABSTRACT: -- No abstract --

4 Guideline Combination therapy in hypertension. 2010

Gradman, Alan H / Basile, Jan N / Carter, Barry L / Bakris, George L / Anonymous4890657. ·The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania and Temple University School of Medicine, Philadelphia, PA 15224, USA. grandmamd@aol.com ·J Am Soc Hypertens · Pubmed #20374950.

ABSTRACT: The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. It is within this context that the American Society of Hypertension presents this Position Paper on Combination Therapy for Hypertension. It will address the scientific basis of combination therapy, present the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. The advantages and disadvantages of single pill (fixed) drug combinations, and the implications of recent clinical trials involving specific combination strategies will also be discussed.

5 Editorial Guidelines for use of diuretics: a view from a member of JNC 7. 2012

Carter, Barry L. · ·J Clin Hypertens (Greenwich) · Pubmed #22533652.

ABSTRACT: -- No abstract --

6 Review Team-Based Care with Pharmacists to Improve Blood Pressure: a Review of Recent Literature. 2018

Kennelty, Korey A / Polgreen, Linnea A / Carter, Barry L. ·Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA. korey-kennelty@uiowa.edu. · Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. korey-kennelty@uiowa.edu. · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, 115 S. Grand Ave, Iowa City, IA, 52242, USA. · Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. ·Curr Hypertens Rep · Pubmed #29349522.

ABSTRACT: PURPOSE OF REVIEW: We review studies published since 2014 that examined team-based care strategies and involved pharmacists to improve blood pressure (BP). We then discuss opportunities and challenges to sustainment of team-based care models in primary care clinics. RECENT FINDINGS: Multiple studies presented in this review have demonstrated that team-based care including pharmacists can improve BP management. Studies highlighted the cost-effectiveness of a team-based pharmacy intervention for BP control in primary care clinics. Little information was found on factors influencing sustainability of team-based care interventions to improve BP control. Future work is needed to determine the best populations to target with team-based BP programs and how to implement team-based approaches utilizing pharmacists in diverse clinical settings. Future studies need to not only identify unmet clinical needs but also address reimbursement issues and stakeholder engagement that may impact sustainment of team-based care interventions.

7 Review Research Needs to Improve Hypertension Treatment and Control in African Americans. 2016

Whelton, Paul K / Einhorn, Paula T / Muntner, Paul / Appel, Lawrence J / Cushman, William C / Diez Roux, Ana V / Ferdinand, Keith C / Rahman, Mahboob / Taylor, Herman A / Ard, Jamy / Arnett, Donna K / Carter, Barry L / Davis, Barry R / Freedman, Barry I / Cooper, Lisa A / Cooper, Richard / Desvigne-Nickens, Patrice / Gavini, Nara / Go, Alan S / Hyman, David J / Kimmel, Paul L / Margolis, Karen L / Miller, Edgar R / Mills, Katherine T / Mensah, George A / Navar, Ann M / Ogedegbe, Gbenga / Rakotz, Michael K / Thomas, George / Tobin, Jonathan N / Wright, Jackson T / Yoon, Sung Sug Sarah / Cutler, Jeffrey A / Anonymous7660880. ·From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (P.K.W., K.C.F.), and Department of Medicine, Tulane University School of Medicine (P.K.W., K.C.F.), New Orleans, LA · Division of Cardiovascular Sciences (P.T.E., P.D.-N., G.A.M., J.A.C.), and Center for Translation Research and Implementation Science (N.G., G.A.M.), National Heart, Lung, and Blood Institute, Bethesda, MD · Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (P.M.) · Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A., L.A.C., E.R.M.) · Preventive Medicine Section, Veterans Affairs Medical Center, Memphis, TN (W.C.C.) · Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA (A.V.D.R.) · Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, OH (M.R., J.T.W.) · Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA (H.A.T.) · Department of Epidemiology and Prevention (J.A.) and Department of Medicine (B.I.F., J.A.), Wake Forest School of Medicine, Wake Forest University, Winston Salem, NC · Dean's Office, University of Kentucky College of Public Health, Lexington (D.K.A.) · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City (B.L.C.) · Department of Biostatistics, University of Texas School of Public Health, Houston (B.R.D.) · Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, IL (R.C.) · Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.) · Department of Internal Medicine, Baylor College of Medicine, Houston, TX (D.J.H.) · National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (P.L.K.) · HealthPartners Institute, Minneapolis, MN (K.L.M.) · Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.M.N.) · Department of Population Health, NYU School of Medicine, New York (G.O.) · American Medical Association, Chicago, IL (M.K.R.) · Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.) · Clinical Directors Network (CND) and The Rockefeller University Center for Clinical and Translational Science, New York (J.N.T.) · and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD (S.S.(S.)Y.). ·Hypertension · Pubmed #27620388.

ABSTRACT: -- No abstract --

8 Review Primary Care Physician-Pharmacist Collaborative Care Model: Strategies for Implementation. 2016

Carter, Barry L. ·The Patrick E. Keefe Professor of Pharmacy, Department of Pharmacy Practice and Science, College of Pharmacy and Professor, University of Iowa, Iowa City, Iowa. · Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa. ·Pharmacotherapy · Pubmed #26931738.

ABSTRACT: The Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) trial recently found that a pharmacist intervention for hypertension could be implemented in diverse medical offices. In this issue of Pharmacotherapy, the article by Brian Isetts and colleagues discusses the complexity of the patient population, the specific functions the pharmacists performed, and the time estimates from billing records used to quantify time spent during face-to-face patient encounters. This invited commentary will discuss findings from the CAPTION trial and provide recommendations for strategies to implement similar interventions for patients with other chronic medical conditions seen in primary care practices.

9 Review The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy. 2012

Carter, Barry L / Bosworth, Hayden B / Green, Beverly B. ·Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA. barry-carter@uiowa.edu ·J Clin Hypertens (Greenwich) · Pubmed #22235824.

ABSTRACT: Team-based care is one of the key components of the patient-centered medical home. Studies have consistently demonstrated that teams involving pharmacists or nurses in patient management can significantly improve blood pressure control. These findings have been demonstrated in several meta-analyses and systematic reviews. These reviews have generally found that team-based care can reduce systolic blood pressure by 4-10 mm Hg over usual care. However, these reviews have also concluded that many of the studies had various limitations and that additional research should be conducted. The present state of the art review paper will highlight newer studies, many of which were funded by the National Institutes of Health. Newer strategies involve telephone and/or web-based management which is an evolving area to improve blood pressure control in large populations. Social media and other technology is currently being investigated to assist pharmacists or nurses in communicating with patients to improve hypertension management. Few cost-effectiveness analyses have been performed but generally have found favorable costs for team-based care when considering the potential to reduce morbidity and mortality. The authors will suggest additional research that needs to be conducted to help evaluate strategies to best implement team-based care to improve blood pressure management.

10 Review Thiazide and loop diuretics. 2011

Sica, Domenic A / Carter, Barry / Cushman, William / Hamm, Lee. ·Department of Medicine, Section of Clinical Pharmacology and Hypertension, Virginia Commonwealth University Health System, MCV Station, Richmond, VA, USA. dsica@mcvh-vcu.edu ·J Clin Hypertens (Greenwich) · Pubmed #21896142.

ABSTRACT: KEY POINTS AND PRACTICAL RECOMMENDATIONS: •  Although chlorthalidone and hydrochlorothiazide are structurally similar, they are very different pharmacokinetically, with chlorthalidone having both an extremely long half-life (approximately 40 to 60 hours) and a large volume of distribution, with gradual elimination from the plasma compartment by tubular secretion. •  Furosemide usage, the most widely used diuretic in the loop diuretic class, can be complicated by extremely erratic absorption, with a bioavailability range of 12% to 112%. •  Chlorthalidone, at a dose of 25 mg, is comparatively more potent than 50 mg of hydrochlorothiazide, particularly as related to overnight blood pressure reduction. •  In ALLHAT, there was no difference among chlorthalidone, amlodipine, lisinopril, and doxazosin for the primary outcome or mortality. •  Secondary outcomes were similar except for a 38% higher rate of heart failure with amlodipine; a 10% higher rate of combined cardiovascular disease, a 15% higher rate of stroke, and a 19% higher rate of heart failure with lisinopril; and a 20% higher rate of cardiovascular disease, a 20% higher rate of stroke (40% higher rate in blacks), and an 80% higher rate of heart failure with doxazosin, compared with chlorthalidone. •  The ACCOMPLISH study may affect future practice guidelines as a result of its findings favoring the amlodipine/benazepril combination; however, the generalizability to patient populations with a lesser cardiovascular risk profile remains in question and the dose of hydrochlorothiazide was only 12.5 mg to 25 mg daily, which was a dose lower than that used in placebo-controlled trials using hydrochlorothiazide. •  Certain low-renin patient groups (eg, blacks, the elderly, and diabetics) as well as those who manifest the metabolic syndrome are commonly more responsive to thiazide-type diuretic therapy. •  Diuretics can be successfully combined with β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, centrally acting agents, and even calcium channel blockers. •  Although thiazide-type diuretics are among the best-tolerated antihypertensive agents in terms of symptomatic adverse effects, diuretic-related adverse side effects include those with established mechanisms (eg, such as electrolyte changes and/or metabolic abnormalities) and other side effects, which are less well understood mechanistically (eg, impotence), although the latter is not universally accepted as a diuretic-related side effect. •  Thiazide-induced hypokalemia is associated with increased blood glucose, and treatment of thiazide-induced hypokalemia may reverse glucose intolerance and possibly prevent diabetes. •  Thiazide-induced hyperuricemia occurs as a result of volume contraction and competition with uric acid for renal tubular secretion, but does not necessarily contraindicate using a thiazide, especially if a uric acid-lowering drug such as allopurinol is being used. •  Adverse interactions include the blunting of thiazide effects by nonsteroidal anti-inflammatory drugs and the potential to increase fatigue, lethargy, and increase in glucose when combined with β-blockers. •  Thiazide-type diuretics are useful first-line agents in the treatment of hypertension because they have been proven to reduce cardiovascular mortality and morbidity in systolic and diastolic forms of hypertension and do so at low cost. •  Loop diuretics should not be used as first-line therapy in hypertension since there are no outcome data with them. They should be reserved for conditions of clinically significant fluid overload (eg, heart failure and significant fluid retention with vasodilator drugs, such as minoxidil) or with advanced renal failure and can be combined with thiazide-type diuretics.

11 Review Role of collaborative care models including pharmacists in improving blood pressure management in chronic kidney disease patients. 2011

St Peter, Wendy L / Farley, T Michael / Carter, Barry L. ·College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55404, USA. stpet002@umn.edu ·Curr Opin Nephrol Hypertens · Pubmed #21709550.

ABSTRACT: PURPOSE OF REVIEW: Inadequately controlled blood pressure is considered an important risk factor for both chronic kidney disease (CKD) progression and cardiovascular disease progression in CKD patients. Patients with CKD and hypertension are typically followed in primary care practice settings and blood pressure is not controlled in a sizeable proportion. This review will focus on the evidence which demonstrates the important role of the pharmacist in collaboration with physicians within primary care practices to improve blood pressure management in CKD patients. RECENT FINDINGS: Several lines of evidence show that pharmacists working in collaboration with primary care physicians can improve blood pressure management as compared with usual care with a physician alone. The major effects of pharmacist intervention are to intensify antihypertensive regimens and improve medication adherence. SUMMARY: Currently, hypertension is not well controlled in a significant proportion of individuals with CKD. Recent studies in the CKD population support evidence from the general population that pharmacists as part of the collaborative care team improves blood pressure management. Research is needed to demonstrate cost-effectiveness of collaborative care models in management of hypertension and other comorbid conditions in CKD patients.

12 Review Comparative effectiveness research: evaluating pharmacist interventions and strategies to improve medication adherence. 2010

Carter, Barry L / Foppe van Mil, J W. ·Department of Pharmacy Practice and Science, College of Pharmacy, Iowa City, Iowa, USA. barry-carter@uiowa.edu ·Am J Hypertens · Pubmed #20651698.

ABSTRACT: One very effective strategy to achieve good blood pressure (BP) control in primary care is the use of physician/pharmacist collaborative management. Interventions by pharmacists in both community pharmacies and primary care clinics have been shown to significantly reduce BP by both improving medication adherence and intensifying medications. This review will evaluate the strengths and weaknesses of various health services' research study designs that assess various pharmacy interventions to improve BP control. We will also evaluate strategies to measure medication adherence used in research studies, and in some cases, clinical practice. Although poor medication adherence is a major cause of inadequate BP control, suboptimal medication regimens are often more common reasons for poor BP control in typical primary care practice. This review proposes strategies to implement stronger interventions and more robust study designs in comparative effectiveness trials that evaluate team-based care for improving BP control.

13 Clinical Trial Effect of self-efficacy and social support on adherence to antihypertensive drugs. 2010

Criswell, Thomas J / Weber, Cynthia A / Xu, Yinghui / Carter, Barry L. ·Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa 52242, USA. ·Pharmacotherapy · Pubmed #20411995.

ABSTRACT: STUDY OBJECTIVE: To determine the relationship between poor adherence and self-efficacy or social support after a pharmacist intervention. DESIGN: Post-hoc analysis of data from two randomized controlled trials of physician-pharmacist collaborative interventions (6 and 9 mo, respectively) to improve blood pressure control. SETTING: Eleven university-affiliated primary care clinics. PATIENTS: Five hundred eighty-four patients (aged 21-85 yrs) with uncontrolled primary hypertension; 296 were in the intervention group and 288 were in the control group. INTERVENTION: Pharmacists provided intensified hypertension management and drug adherence counseling to patients in the intervention group. MEASUREMENTS AND MAIN RESULTS: Social support and self-efficacy questionnaires were administered at baseline and end-of-study visits. Patient adherence was monitored by using the Morisky self-reported adherence questionnaire. Self-reported adherence scores improved significantly in the control group (p=0.0053) but not in the intervention group; however, adherence at baseline in both groups was high. There were small, but significant, improvements in self-efficacy (p<0.04) and social support (p<0.05) scores in the intervention group but not the control group at the end of the study. Social support and, to a lesser extent, self-efficacy improved as a function of duration of study participation (9-mo vs 6-mo intervention), regardless of whether the patient received the intervention. Blood pressure control in both groups improved significantly at the end of the study; however, mean blood pressure was significantly lower in the intervention group (129.7/76.6 mm Hg) compared with the control group (140.8/78.9 mm Hg; p<0.0001 for systolic, p=0.032 for diastolic). CONCLUSION: Social support and self-efficacy improved significantly in the intervention group at the end of the pharmacist intervention. Drug adherence was correlated with self-efficacy even though drug adherence did not improve significantly in the intervention group. The fact that social support and self-efficacy improved as a function of duration of study participation suggests that participation in a research study may have had a positive influence on these measures. Even though the changes in social support, self-efficacy, and drug adherence were modest, there was significantly better blood pressure control in the intervention group compared with the control group. These findings indicate that changes in drug adherence, self-efficacy, or social support probably played a minor role in the blood pressure outcomes in these studies.

14 Article A texting-based blood pressure surveillance intervention. 2019

Zahr, Roula S / Anthony, Chris A / Polgreen, Philip M / Simmering, Jacob E / Goerdt, Christopher J / Hoth, Angela B / Miller, Michelle L / Suneja, Manish / Segre, Alberto M / Carter, Barry L / Cavanaugh, Joseph E / Polgreen, Linnea A. ·Department of Internal Medicine, Oregon Health Sciences University, Portland, OR, USA. · Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA. · Department of Internal Medicine, University of Iowa, Iowa City, IA, USA. · Department of Epidemiology, University of Iowa, Iowa City, IA, USA. · Department of Computer Science, University of Iowa, Iowa City, IA, USA. · Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA. · Department of Family Practice, University of Iowa, Iowa City, IA, USA. · Department of Biostatistics, University of Iowa, Iowa City, IA, USA. ·J Clin Hypertens (Greenwich) · Pubmed #31503408.

ABSTRACT: The authors examined whether using home BP measurements collected via a custom-built bi-directional-texting platform incorporated into patients' electronic medical records would lead to treatment calibration and improved BP management. Patients were randomized to either the intervention group and collected home measurements based on reminders and reported via bi-directional texting, or to the control group, with home BP measurement reporting via standard practice (eg, phone, electronic medical record portal) and instructed to return 7 morning and 7 evening BP measurements. Outcomes included number of BP measurements submitted, the number of medication changes, reduction in BP, and BP control. 72% of the intervention group submitted at least 14 readings, compared with 45% of the control group. BP control improved in both groups. However, the authors found no statistically significant difference in BP or the number of BP-medication changes at 1, 3, or 6 months compared with the control group.

15 Article Efficacy of Patient Activation Interventions With or Without Financial Incentives to Promote Prescribing of Thiazides and Hypertension Control: A Randomized Clinical Trial. 2018

Kaboli, Peter J / Howren, M Bryant / Ishani, Areef / Carter, Barry / Christensen, Alan J / Vander Weg, Mark W. ·Center for Comprehensive Access & Delivery Research & Evaluation, Veterans Affairs Iowa City Healthcare System, Iowa City, Iowa. · Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City. · Department of Psychological and Brain Sciences, The University of Iowa College of Liberal Arts and Sciences, Iowa City. · Center for Epidemiology and Clinical Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota. · Section of Nephrology, Department of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota. · Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis. · Department of Pharmacy Practice and Science, The University of Iowa College of Pharmacy, Iowa City. · Department of Family Medicine, The University of Iowa Carver College of Medicine, Iowa City. ·JAMA Netw Open · Pubmed #30646291.

ABSTRACT: Importance: Evidence-based guidelines recommend thiazide diuretics as a first-line therapy for uncomplicated hypertension; however, thiazides are underused, and hypertension remains inadequately managed. Objective: To test the efficacy of a patient activation intervention with financial incentives to promote thiazide prescribing. Design, Setting, and Participants: The Veterans Affairs Project to Implement Diuretics, a randomized clinical trial, was conducted at 13 Veterans Affairs primary care clinics from August 1, 2006, to July 31, 2008, with 12 months of follow-up. A total of 61 019 patients were screened to identify 2853 eligible patients who were not taking a thiazide and not at their blood pressure (BP) goal; 598 consented to participate. Statistical analysis was conducted from December 1, 2017, to September 12, 2018. Interventions: Patients were randomized to a control group (n = 196) or 1 of 3 intervention groups designed to activate patients to talk with their primary care clinicians about thiazides and hypertension: group A (n = 143) received an activation letter, group B (n = 128) received a letter plus a financial incentive, and group C (n = 131) received a letter, financial incentive, and a telephone call encouraging patients to speak with their primary care clinicians. Main Outcomes and Measures: Primary outcomes were thiazide prescribing and BP control. A secondary process measure was discussion between patient and primary care clinician about thiazides. Results: Among 598 participants (588 men and 10 women), the mean (SD) age for the combined intervention groups (n = 402) was 62.9 (8.8) years, and the mean baseline BP was 148.1/83.8 mm Hg; the mean (SD) age for the control group (n = 196) was 64.1 (9.2) years, and the mean baseline BP was 151.0/83.4 mm Hg. At index visits, the unadjusted rate of thiazide prescribing was 9.7% for the control group (19 of 196) and 24.5% (35 of 143) for group A, 25.8% (33 of 128) for group B, and 32.8% (43 of 131) for group C (P < .001). Adjusted analyses demonstrated an intervention effect on thiazide prescribing at the index visit and 6-month visit, which diminished at the 12-month visit. For BP control, there was a significant intervention effect at the 12-month follow-up for group C (adjusted odds ratio, 1.73; 95% CI, 1.06-2.83; P = .04). Intervention groups exhibited improved thiazide discussion rates in a dose-response fashion: group A, 44.1% (63 of 143); group B, 56.3% (72 of 128); and group C, 68.7% (90 of 131) (P = .004). Conclusions and Relevance: This patient activation intervention about thiazides for hypertension resulted in two-thirds of patients having discussions and nearly one-third initiating a prescription of thiazide. Adding a financial incentive and telephone call to the letter resulted in incremental improvements in both outcomes. By 12 months, improved BP control was also evident. This low-cost, low-intensity intervention resulted in high rates of discussions between patients and clinicians and subsequent thiazide treatment and may be used to promote evidence-based guidelines and overcome clinical inertia. Trial Registration: ClinicalTrials.gov Identifier: NCT00265538.

16 Article Pharmacist Intervention for Blood Pressure Control in Patients with Diabetes and/or Chronic Kidney Disease. 2018

Anderegg, Maxwell D / Gums, Tyler H / Uribe, Liz / MacLaughlin, Eric J / Hoehns, James / Bazaldua, Oralia V / Ives, Timothy J / Hahn, David L / Coffey, Christopher S / Carter, Barry L. ·Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, Iowa. · Division of Health Outcomes and Pharmacy Practice, College of Pharmacy, University of Texas, Austin, Texas. · Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa. · Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas. · Northeast Iowa Medical Education Foundation, Waterloo, Iowa. · Department of Family and Community Medicine, The University of Texas Health Sciences Center at San Antonio, San Antonio, Texas. · UNC Eshelman School of Pharmacy and the Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. · Wisconsin Research and Education Network, University of Wisconsin, Madison, Wisconsin. · Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa. ·Pharmacotherapy · Pubmed #29331037.

ABSTRACT: OBJECTIVES: The objectives of this study were to determine if hypertensive patients with comorbid diabetes mellitus (DM) and/or chronic kidney disease (CKD) receiving a pharmacist intervention had a greater reduction in mean blood pressure (BP) and improved BP control at 9 months compared with those receiving usual care; and compare Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guideline and 2014 guideline (JNC 8) BP control rates in patients with DM and/or CKD. METHODS: This cluster randomized trial included 32 medical offices in 15 states. Clinical pharmacists made treatment recommendations to physicians at intervention sites. This post hoc analysis evaluated mean BP and BP control rates in the intervention and control groups. MAIN RESULTS: The study included 335 patients (227 intervention, 108 control) when mean BP and control rates were evaluated by JNC 7 inclusion and control criteria. When JNC 8 inclusion and control criteria were applied, 241 patients (165 intervention, 76 control) remained and were included in the analysis. The pharmacist-intervention group had significantly greater mean systolic blood pressure reduction compared with usual care at 9 months (8.64 mm Hg; 95% confidence interval [CI] -12.8 to -4.49, p<0.001). The pharmacist-intervention group had significantly higher BP control at 9 months than usual care by either the JNC 7 or JNC 8 inclusion and control groups (adjusted odds ratio [OR] 1.97, 95% CI 1.01-3.86, p=0.0470 and OR 2.16, 95% CI 1.21-3.85, p=0.0102, respectively). PRINCIPAL CONCLUSIONS: This study demonstrated that a physician-pharmacist collaborative intervention was effective in reducing mean systolic BP and improving BP control in patients with uncontrolled hypertension with DM and/or CKD, regardless of which BP guidelines were used.

17 Article Collaborative care model for hypertension. 2018

Carter, Barry L. ·Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA. · Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. ·J Clin Hypertens (Greenwich) · Pubmed #29237101.

ABSTRACT: -- No abstract --

18 Article Selection bias and subject refusal in a cluster-randomized controlled trial. 2017

Yang, Rochelle / Carter, Barry L / Gums, Tyler H / Gryzlak, Brian M / Xu, Yinghui / Levy, Barcey T. ·Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA, 52242, USA. · Department of Pharmacy Practice & Science, College of Pharmacy, University of Iowa, Iowa City, IA, 52242, USA. barry-carter@uiowa.edu. · Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. barry-carter@uiowa.edu. · Department of Health Outcomes and Pharmacy Practice, University of Texas, Austin, TX, USA. · Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA. · Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. ·BMC Med Res Methodol · Pubmed #28693427.

ABSTRACT: BACKGROUND: Selection bias and non-participation bias are major methodological concerns which impact external validity. Cluster-randomized controlled trials are especially prone to selection bias as it is impractical to blind clusters to their allocation into intervention or control. This study assessed the impact of selection bias in a large cluster-randomized controlled trial. METHODS: The Improved Cardiovascular Risk Reduction to Enhance Rural Primary Care (ICARE) study examined the impact of a remote pharmacist-led intervention in twelve medical offices. To assess eligibility, a standardized form containing patient demographics and medical information was completed for each screened patient. Eligible patients were approached by the study coordinator for recruitment. Both the study coordinator and the patient were aware of the site's allocation prior to consent. Patients who consented or declined to participate were compared across control and intervention arms for differing characteristics. Statistical significance was determined using a two-tailed, equal variance t-test and a chi-square test with adjusted Bonferroni p-values. Results were adjusted for random cluster variation. RESULTS: There were 2749 completed screening forms returned to research staff with 461 subjects who had either consented or declined participation. Patients with poorly controlled diabetes were found to be significantly more likely to decline participation in intervention sites compared to those in control sites. A higher mean diastolic blood pressure was seen in patients with uncontrolled hypertension who declined in the control sites compared to those who declined in the intervention sites. However, these findings were no longer significant after adjustment for random variation among the sites. After this adjustment, females were now found to be significantly more likely to consent than males (odds ratio = 1.41; 95% confidence interval = 1.03, 1.92). CONCLUSIONS: Though there appeared to be a higher consent rate for females than for males, the overall impact of potential selection bias and refusal to participate was minimal. Without rigorous methodology, selection bias may be a threat to external validity in cluster-randomized trials. TRIAL REGISTRATION: NCT01983813 . Date of registration: Oct. 28, 2013.

19 Article Cost-utility analysis of physician-pharmacist collaborative intervention for treating hypertension compared with usual care. 2017

Kulchaitanaroaj, Puttarin / Brooks, John M / Chaiyakunapruk, Nathorn / Goedken, Amber M / Chrischilles, Elizabeth A / Carter, Barry L. ·aDepartment of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa, USA bHealth Economics Research Group (HERG), Department of Life Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom cDepartment of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA dSchool of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia eCenter of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand fSchool of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA gSchool of Population Health, University of Queensland, Brisbane, Queensland, Australia hDepartment of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA. ·J Hypertens · Pubmed #27684354.

ABSTRACT: OBJECTIVE: To estimate long-term costs and outcomes attributable to a physician-pharmacist collaborative intervention compared with physician management alone for treating essential hypertension. METHODS: A Markov model cohort simulation with a 6-month cycle length to predict acute coronary syndrome, stroke, and heart failure throughout lifetime was performed. A cohort of 399 patients was obtained from two prospective, cluster randomized controlled clinical trials implementing physician-pharmacist collaborative interventions in community-based medical offices in the Midwest, USA. Framingham risk equations and other algorithms were used to predict the vascular diseases. SBP reduction due to the interventions deteriorated until 5 years. Direct medical costs using a payer perspective were adjusted to 2015 dollar value, and the main outcome was quality-adjusted life years (QALYs); both were discounted at 3%. The intervention costs were estimated from the trials, whereas the remaining parameters were from published studies. A series of sensitivity analyses including changing patient risks of vascular diseases, probabilistic sensitivity analysis, and a cost-effectiveness acceptability curve were performed. RESULTS: The lifetime incremental costs were $26 807.83 per QALY (QALYs gained = 0.14). The intervention provided the greatest benefit for the high-risk patients, moderate benefit for the trial patients, and the lowest benefit for the low-risk patients. If a payer is willing to pay $50 000 per QALY gained, in 48.6% of the time the intervention would be cost-effective. CONCLUSION: Team-based care such as a physician-pharmacist collaboration appears to be a cost-effective strategy for treating hypertension. The intervention is most cost-effective for high-risk patients.

20 Article Physician-Pharmacist Collaborative Management: Narrowing the Socioeconomic Blood Pressure Gap. 2016

Anderegg, Maxwell D / Gums, Tyler H / Uribe, Liz / Coffey, Christopher S / James, Paul A / Carter, Barry L. ·From the Department of Pharmacy Practice & Science, College of Pharmacy (M.D.A., B.L.C.), Department of Biostatistics, College of Public Health (L.U., C.S.C.), and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine (P.A.J., B.L.C.), University of Iowa · and Department of Health Outcomes & Pharmacy Practice, College of Pharmacy, University of Texas at Austin (T.H.G.). ·Hypertension · Pubmed #27600181.

ABSTRACT: Physician-pharmacist collaboration improves blood pressure, but there is little information on whether this model can reduce the gap in healthcare disparities. This trial involved 32 medical offices in 15 states. A clinical pharmacist was embedded within each office and made recommendations to physicians and patients in intervention offices. The purpose of the present analysis was to evaluate whether the pharmacist intervention could reduce healthcare disparities by improving blood pressure in high-risk racial and socioeconomic subjects compared with the control group. The analyses in minority subjects were prespecified secondary analyses, but all other comparisons were secondary, post hoc analyses. The 9-month visit was completed by 539 patients: 345 received the intervention, and 194 were in the control group. Following the intervention, mean systolic blood pressure was found to be 7.3 mm Hg (95% confidence interval 2.4, 12.3) lower in subjects from racial minority groups who received the intervention compared with the control group (P=0.0042). Subjects with ≤12 years of education in the intervention group had a systolic blood pressure 8.1 mm Hg (95% confidence interval 3.2, 13.1) lower than the control group with lower education (P=0.0001). Similar reductions in blood pressure occurred in patients with low incomes, those receiving Medicaid, or those without insurance. This study demonstrated that a pharmacist intervention reduced racial and socioeconomic disparities in the treatment of blood pressure. Although disparities in blood pressure were reduced by the intervention, there were still nonsignificant gaps in mean systolic blood pressure when compared with intervention subjects not at risk. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00935077.

21 Article Evaluation of Pharmacists' Work in a Physician-Pharmacist Collaborative Model for the Management of Hypertension. 2016

Isetts, Brian J / Buffington, Daniel E / Carter, Barry L / Smith, Marie / Polgreen, Linnea A / James, Paul A. ·Department of Pharmaceutical Care & Health Systems, University of Minnesota College of Pharmacy, Minneapolis, Minnesota. · College of Medicine and Pharmacy, University of South Florida, Tampa, Florida. · The Patrick E. Keefe Professor in Pharmacy, The Department of Pharmacy Practice and Science College of Pharmacy, and Professor, The University of Iowa, Iowa City, Iowa. · Department of Family Medicine, The Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa. · Henry A. Palmer, Professor at the University of Connecticut School of Pharmacy, Storrs, Connecticut. · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa. · The Donald J. and Anna M. Ottilie Chair and Professor in the Department of Family Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa. ·Pharmacotherapy · Pubmed #26893135.

ABSTRACT: STUDY OBJECTIVE: Physician-pharmacist collaborative models have been shown to improve the care of patients with numerous chronic medical conditions. Team-based health care using integrated clinical pharmacists provides one opportunity to improve quality in health care systems that use population-based financing. In November 2015, the Centers for Medicare and Medicaid Services (CMS) requested that the relative value of pharmacists' work in team-based care needs to be established. Thus the objective of this study was to describe the components of pharmacists' work in the management of hypertension with a physician-pharmacist collaborative model. DESIGN: Descriptive analysis of the components of pharmacists' work in the Collaboration Among Pharmacists and Physicians to Improve Outcomes Now (CAPTION) study, a prospective, cluster randomized trial. MEASUREMENTS AND MAIN RESULTS: This analysis was intended to provide policymakers with data and information, using the CAPTION study model, on the time and intensity of pharmacists' work to understand pharmacists' relative value contributions in the context of CMS financing and population management aims. The CAPTION trial was conducted in 32 community-based medical offices in 15 U.S. states and included 390 patients with multiple cardiovascular risk factors. Blood pressure was measured by trained study coordinators in each office, and patients were included in the study if they had uncontrolled blood pressure. Included patients were randomized to a 9-month intervention, a 24-month intervention, or usual care. The goal of the pharmacist intervention was to improve blood pressure control and resolve drug therapy problems impeding progress toward blood pressure goals. This intervention included medical record review, a structured assessment with the patient, collaboration to achieve goals of therapy, and patient follow-up. The two intervention arms (9 and 24 mo) were identical the first 9 months, and that time frame is the focus of this workload evaluation. Pharmacists completed study encounter forms for every patient encounter and estimated time spent in pre-visit, face-to-face care, and post-visit activities. Among the 390 patients, there were 2811 encounters with pharmacists that involved 3.44 hours/patient for face-to-face care visits plus 1.55 hours/patient for pre-visit and post-visit work. Intensity of work was reflected in interventions to resolve drug therapy problems with patients (43% of encounters) and with physicians (1169 recommendations, of which physicians accepted 1153 [98.6%]), resulting in improvement of patients' blood pressure goals achieved (from 0% at baseline to 43% at 9 months based on the primary study end point). CONCLUSION: Pharmacists provided extensive interventions to patients with hypertension. This analysis provides a framework for health systems, provider groups, and payers to measure pharmacists' work in value-based financing and population management.

22 Article Physician-pharmacist collaboration versus usual care for treatment-resistant hypertension. 2016

Smith, Steven M / Carris, Nicholas W / Dietrich, Eric / Gums, John G / Uribe, Liz / Coffey, Christopher S / Gums, Tyler H / Carter, Barry L. ·Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA; Department of Community Health & Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA. Electronic address: ssmith@cop.ufl.edu. · Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA; Department of Family Medicine, College of Medicine, University of South Florida, Tampa, FL, USA. · Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA; Department of Community Health & Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA. · Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA. · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. ·J Am Soc Hypertens · Pubmed #26852290.

ABSTRACT: Team-based care has been recommended for patients with treatment-resistant hypertension (TRH), but its efficacy in this setting is unknown. We compared a physician-pharmacist collaborative model (PPCM) to usual care in patients with TRH participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now study. At baseline, 169 patients (27% of Collaboration Among Pharmacists and Physicians To Improve Outcomes Now patients) had TRH: 111 received the PPCM intervention and 58 received usual care. Baseline characteristics were similar between treatment arms. After 9 months, adjusted mean systolic blood pressure was reduced by 7 mm Hg more with PPCM intervention than usual care (P = .036). Blood pressure control was 34.2% with PPCM versus 25.9% with usual care (adjusted odds ratio, 1.92; 95% confidence interval, 0.33-11.2). These findings suggest that team-based care in the primary care setting may be effective for TRH. Additional research is needed regarding the long-term impact of these models and to identify patients most likely to benefit from team-based interventions.

23 Article Cost-Effectiveness of a Physician-Pharmacist Collaboration Intervention to Improve Blood Pressure Control. 2015

Polgreen, Linnea A / Han, Jayoung / Carter, Barry L / Ardery, Gail P / Coffey, Christopher S / Chrischilles, Elizabeth A / James, Paul A. ·From the Department of Pharmacy Practice and Science, College of Pharmacy (L.A.P., B.L.C., G.P.A.), Department of Family Medicine, College of Medicine (B.L.C., P.A.J.), Departments of Biostatistics (C.S.C.) and Epidemiology (E.A.C.), College of Public Health (E.A.C., C.S.C.), University of Iowa, Iowa City · and Department of Pharmacy Practice, School of Pharmacy, Fairleigh Dickinson University, Madison, NJ (J.H.). ·Hypertension · Pubmed #26527048.

ABSTRACT: Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability, lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now (CAPTION) trial randomized 625 patients from 32 medical offices in 15 states. Each office had an existing clinical pharmacist on staff. Pharmacists in intervention offices communicated with patients and made recommendations to physicians about changes in therapy. Demographic information, blood pressure (BP), medications, and physician visits were recorded. In addition, pharmacists tracked time spent with each patient. Costs were assigned to medications and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in BP measurements and hypertension control rates. Thirty-eight percent of patients were black, 14% were Hispanic, and 49% had annual income <$25 000. At 9 months, average systolic BP was 6.1 mm Hg lower (±3.5), diastolic was 2.9 mm Hg lower (±1.9), and the percentage of patients with controlled hypertension was 43% in the intervention group and 34% in the control group. Total costs for the intervention group were $1462.87 (±132.51) and $1259.94 (±183.30) for the control group, a difference of $202.93. The cost to lower BP by 1 mm Hg was $33.27 for systolic BP and $69.98 for diastolic BP. The cost to increase the rate of hypertension control by 1 percentage point in the study population was $22.55. Our results highlight the cost-effectiveness of a clinical pharmacy intervention for hypertension control in primary care settings.

24 Article Pharmacist intervention for blood pressure control: medication intensification and adherence. 2015

Gums, Tyler H / Uribe, Liz / Vander Weg, Mark W / James, Paul / Coffey, Christopher / Carter, Barry L. ·Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. Electronic address: tyler-gums@uiowa.edu. · Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA. · Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA; Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA; Department of Psychology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, USA. · Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. · Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA; Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA. ·J Am Soc Hypertens · Pubmed #26077795.

ABSTRACT: The objective of this study was to describe medication adherence and medication intensification in a physician-pharmacist collaborative management (PPCM) model compared with usual care. This study was a prospective, cluster, randomized study in 32 primary care offices from 15 states. The primary outcomes were medication adherence and anti-hypertensive medication changes during the first 9 months of the intervention. The 9-month visit was completed by 539 patients, 345 of which received the intervention. There was no significant difference between intervention and usual care patients in regards to medication adherence at 9 months. Intervention patients received significantly more medication changes (4.9 vs.1.1; P = .0003) and had significantly increased use of diuretics and aldosterone antagonists when compared with usual care (P = .01).The PPCM model increased medication intensification; however, no significant change in medication adherence was detected. PPCM models will need to develop non-adherence identification and intervention methods to further improve the potency of the care team.

25 Article Will Team-Based Care Really be Implemented? 2015

Carter, Barry L. ·Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA. · Department of Family Medicine, College of Medicine, University of Iowa, Iowa City, IA. ·J Clin Hypertens (Greenwich) · Pubmed #26032927.

ABSTRACT: -- No abstract --

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