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 The leading web portal for pharmacy resources, news, education and careers August 22, 2017
Pharmacy Choice - Hypertension Disease State Management - August 22, 2017

Hypertension Disease State Management

Hypertension Patients – the Pharmacist as Patient Risk Manager
by Ken Baker, BS Pharm, JD

Today's pharmacist has several profession roles, many of which have evolved in just the last generation of pharmacists. In Kampe v Stark the Missouri appellate court held, "By properly filling legal prescriptions that contained no apparent discrepancies on their face, the pharmacy fulfilled its duty to appellant."1 That was in1992 when in large parts of the country a pharmacist's only job was to lick, stick, count, and pour. Only six year later Kampe was overruled in the case of Horner v. Spalitto2, which held, a pharmacist's "education and expertise will require that he or she do more to help protect their patrons from risks which pharmacists can reasonably foresee."2

To Monitor, To Warn
The Horner case held a pharmacist may have an additional duty to warn and to monitor.2 A duty to warn and monitor is a significantly higher professional, if not legal, duty. It is a duty which pharmacists are increasingly embracing. To warn and to monitor defines a role in which pharmacists are becoming their patient's risk manager. It is prospective drug review and communication, which includes written and oral counseling. Increasingly pharmacists are protecting patients and saving lives.

Hypertension is a good example of the impact today's pharmacists can have on health and quality of life. There are an estimated 65 million people in the United States with hypertension3 of which 42 million are uncontrolled.4 Some of these are undiagnosed, but many are patients on medication filled in pharmacies every day. One of the places pharmacists can have the greatest impact lies in the fact "that approximately 50% of individuals discontinue antihypertensive medications within 6 to 12 months of their initiation."4

By embracing the professional duties of prospective drug review, monitoring the patient's use of their drugs, and warning and communicating, pharmacists in their everyday practice are in a position to "significantly decrease the incidence of stroke, ischemic heart disease, congestive heart failure, and renal failure, irrespective of age, gender, race or ethnicity, type of antihypertensive used, or severity of hypertension."4 The best way to explore the difference pharmacists can make is to tell a story.

The Story of Sally
Sally is a widow living on a fixed income5. She lives alone and has, among other ailments, hypertension. The medication the doctor prescribed for this is one of the newer drugs and one of the most expensive. To save money, Sally began taking her high blood pressure medication every other day. It was prescribed to be take daily. Her blood pressure, once under control, is no longer. She is embarrassed that she cannot afford her medicine so she has said nothing to her doctor, her children or her pharmacist. She is not feeling well, but has confided in no one.

While filling Sally's prescriptions the pharmacy technician notices what has not been noticed before – Sally's high blood pressure medication was last filled not the 30 days ago it should have been, but almost 60 days ago. The technician alerts the pharmacist who brings Sally to a private area of the pharmacy as asks her some questions. Sally tells her about taking the medication every other day to save money. The pharmacist has Sally use the pharmacy's blood pressure kiosk to check her readings. While high, it is not immediately alarming. 5

While Sally is still in the pharmacy, her pharmacist calls the doctor. The pharmacist explains the situation and suggests an older, cheaper alternative medication to control Sally's blood pressure. The pharmacist suggests Sally make an appointment to see the doctor and with Sally's permission alerts Sally's daughter. What difference did the pharmacist make?5

A Modern Profession
The profession of pharmacy has changed. Pharmacists today see themselves as a healthcare professional who doesn't just control and oversee the distribution of drugs, but who now use their knowledge and experience to make a real difference in patient's lives. In the story of Sally the pharmacy technician and the pharmacist used the pharmacy's patient medication records and the pharmacists' communication skills to make a difference in a patient's life. It happens every day and in the future will happen more often.

A note: The story of Sally is based on a true incident told by the real "Sally's" daughter. In the actual incident however no one intervened. The real "Sally" did suffer a stroke followed by hospitalization and rehabilitation.

References
  1. Kampe v. Howard Stark Professional Pharmacy, Inc.[,] 841 S.W.2d 223…(Mo.App.1992)
  2. Horner v. Spalitto, 1 S.W.3d 519 (1999)
  3. Rosendorf C et al, Treatment of Hypertension in Patients With Coronary Artery Disease, A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension, http://hyper.ahajournals.org, June 2015.
  4. See, Chobanian AV, Impact of Nonadherence to Antihypertensive Therapy, circ.ahajournals.org Circulation. 2009; 120: 1558-1560, Published online before print October 5, 2009, doi: 10.1161/CIRCULATIONAHA.109.906164; quoting Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones Materson BJ, Oparil S, Wright JT, Roccella EJ, and the National High Blood Pressure Education Program Coordinating Committee. The seventh report the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension. 2003; 42: 12061252.
  5. The story of Sally is based on a true incident told by the real "Sally's" daughter. In the actual incident however no one intervened. The real "Sally" did suffer a stroke followed by hospitalization and rehabilitation. What if the pharmacist in the real case had intervened?


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