Effect of Adding Pharmacists to Primary Care Teams on Blood Pressure Control in Patients with Type 2 Diabetes: A Randomized Controlled Trial (ISRCTN97121854)
- Scot H. Simpson, BSP, PharmD, MSc ()1,
- Sumit R. Majumdar, MD, MPH2,3,
- Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc1,2,3,
- Richard Z. Lewanczuk, MD, PhD2,
- Richard Spooner, MD4 and
- Jeffrey A. Johnson, BSP, PhD2,3
Objective: Evaluate the effect of adding pharmacists to primary care teams on management of hypertension and other cardiovascular risk factors in patients with type 2 diabetes.
Methods: Randomized controlled trial with blinded ascertainment of outcomes conducted in primary care clinics in Edmonton, Canada. Pharmacists performed medication assessments, limited history and physical examinations, and provided guideline-concordant recommendations to optimize medication management. Follow-up contact was completed as necessary. Controls received usual care. The primary outcome was a ≥10% decrease in systolic blood pressure (BP) at 1 year.
Results: 260 patients were enrolled, 57% were women, mean age was 59 years, diabetes duration was 6 years and BP was 129/74 mmHg. 48 of 131 (37%) intervention patients and 30 of 129 (23%) controls achieved the primary outcome (OR 1.9; 95% CI 1.1-3.3; p=0.02). Among the 153 patients with inadequately controlled hypertension at baseline, intervention patients (n=82) were significantly more likely than controls (n=71) to achieve the primary outcome (41[50%] vs 20[28%]; OR 2.6; 95% CI 1.3-5.0; p=0.007) and recommended BP targets (44[54%] vs 21[30%]; OR 2.8; 95% CI 1.4-5.4; p=0.003). Ten-year risk of cardiovascular disease, based on changes to the UKPDS Risk Engine, were predicted to decrease by 3% for intervention patients and 1% for controls (p=0.005).
Conclusions: Significantly more patients with type 2 diabetes achieved better BP control when pharmacists were added to primary care teams, suggesting pharmacists can make important contributions to the primary care of these patients.
- Received July 7, 2010.
- Accepted October 3, 2010.
- Copyright © American Diabetes Association