Pharmacist-led model for screening and Management of Hypertension (Bihar Pharmacist Study)
Pharmacist-led model for screening and Management of Hypertension (Bihar Pharmacist Study)
Year: November 2020
Collaborator: Nano Healthcare
Team: Hemanshu Das, Ashish Sachdeva, Harish Kumar & Sarang Deo
Background
High blood pressure (or hypertension), afflicting 220 million Indians, is the most important preventable risk factor for CVDs and accounts for more than half of the CVD deaths. Over the past twenty years, the prevalence of uncontrolled hypertension in rural India has increased faster than in urban areas owing, in part, to rapid urbanization, lack of formal care in the private sector, and weak non-communicable disease programs in the public sector. Higher disease burden in low-resources settings, such as India, requires innovative solutions for hypertension screening and management. Task- sharing with allied health professionals, such as pharmacists, has been found to be effective in disease management. In rural India, pharmacists are generally the first point of contact for healthcare seekers, thus presenting a unique opportunity to curtail the increasing burden of hypertension by leveraging pharmacist services for screening and management of hypertension.
About the Study
The study involved task-sharing with community pharmacists to evaluate the effect of pharmacist-led blood pressure screening on control and reduction of blood pressure in underserved Indian settings.
Methodology
This retrospective cohort study involved 20 private pharmacies in Bihar where pharmacists monitored the blood pressure of patients and general physicians did free periodic consultations at the pharmacies. Standard protocols under Indian Hypertension Control Initiative (IHCI) were adopted. The number of screenings done, the number of patients enrolled and change in blood pressure values during the treatment were noted using a digital application designed for the study.
Outcome
The Bihar Pharmacist Hypertension Study provides real-world evidence on the impact of task-sharing with pharmacists for hypertension screening and management. In particular, we find that such task-sharing leads to reduction in blood pressure (systolic and diastolic), and increased odds of controlling blood pressure for subjects enrolled in the program, who completed at least one follow up visit. Despite the promising impact on blood pressure, the long-term health outcomes from such a program rely on continued adherence to medication and follow-up with the care provider. Thus, to be successful, team-based care programs involving pharmacists must improve patient retention by focusing on aligning provider and patient incentives to improve quality in terms of patient screenings, enrollment, and retention. Financial incentives, albeit helpful, may not be a sustainable solution given the chronic nature of the disease. Community support and engagement on the other hand can be leveraged to achieve results in the long term.