Identifying masked uncontrolled hypertension in the community pharmacy setting

© 2015 Wolters Kluwer Health, Inc. Masked uncontrolled hypertension (MUCH) is associated with an increased cardiovascular risk. This condition is frequent in the community pharmacy (i.e., CP-MUCH), but there is no evidence on the factors associated with its presence in that setting. The aim of this analysis was to explore these factors. A sample of 98 treated hypertensive patients from the MEPAFAR study, with normal community pharmacy blood pressure (CPBP <135/85 mmHg), were analyzed. Blood pressure (BP) was also measured at home (4 days) and monitored for 24 h. CP-MUCH was identified when either ambulatory (daytime) or home BP averages were equal to or higher than 135/85 mmHg. A multivariate logistic regression analysis was carried out to identify the factors associated with CP-MUCH. The prevalence of CP-MUCH tends to be higher as systolic and diastolic CPBP increase, reaching 47% in patients with both systolicand diastolic CPBP equal to or higher than 123 mmHg and 79 mmHg, respectively.The multivariate regression analysis showed only systolic CPBP as an independent factor of CP-MUCH [≥123 mmHg: odds ratio=16.46 (P=0.012); from 115 to 122.9 mmHg: odds ratio=10.74 (P=0.036); systolic CPBP <115 mmHg as the reference]. Further assessment, using ambulatory and/or home BP monitoring, is recommended in patients with normal CPBP, but systolic CPBP equal to or higher than 115 mmHg. A more feasible approach would be evaluating patients with systolic CPBP equal to or higher than 123 mmHg and diastolic CPBP equal to or higher than 79 mmHg

A stakeholder co-design approach for developing a community pharmacy service to enhance screening and management of atrial fibrillation

The authors would like to thank all participants in this research for their valuable input into the co-design process.Background: Community pharmacies provide a suitable setting to promote self-screening programs aimed at enhancing the early detection of atrial fibrillation (AF). Developing and implementing novel community pharmacy services (CPSs) is a complex and acknowledged challenge, which requires comprehensive planning and the participation of relevant stakeholders. Co-design processes are participatory research approaches that can enhance the development, evaluation and implementation of health services. The aim of this study was to co-design a pharmacist-led CPS aimed at enhancing self-monitoring/screening of AF. Methods: A 3-step co-design process was conducted using qualitative methods: (1) interviews and focus group with potential service users (n = 8) to identify key needs and concerns; (2) focus group with a mixed group of stakeholders (n = 8) to generate a preliminary model of the service; and (3) focus group with community pharmacy owners and managers (n = 4) to explore the feasibility and appropriateness of the model. Data were analysed qualitatively to identify themes and intersections between themes. The JeMa2 model to conceptualize pharmacybased health programs was used to build a theoretical model of the service. Results: Stakeholders delineated: a clear target population (i.e., individuals ≥65 years old, with hypertension, with or without previous AF or stroke); the components of the service (i.e., patient education; self-monitoring at home; results evaluation, referral and follow-up); and a set of circumstances that may influence the implementation of the service (e.g., quality of the service, competency of the pharmacist, inter-professional relationships, etc.). A number of strategies were recommended to enable implementation (e.g.,. endorsement by leading cardiovascular organizations, appropriate communication methods and channels between the pharmacy and the general medical practice settings, etc.). Conclusion: A novel and preliminary model of a CPS aimed at enhancing the management of AF was generated from this participatory process. This model can be used to inform decision making processes aimed at adopting and piloting of the service. It is expected the co-designed service has been adapted to suit existing needs of patients and current care practices, which, in turn, may increase the feasibility and acceptance of the service when it is implemented into a real setting.This work was funded by Covidien Pty Ltd. (Medtronic Australasia Pty Ltd) [UTS Project code: PRO16–0688], which is the company that has the rights to distribute the device Microlife BP A200 AFIB in Australia. Also, funding for this research has been provided by a UTS Chancellor’s postdoctoral fellowship awarded to the first author of this article (ID number: 2013001605)

Intervencion Farmaceutica Intervencion Farmaceutica Plaquetarios En Diabeticos Tipo 2

OBJECTIVES To measure the prevalence of type 2 diabetic patients using antiplatelet platelet therapy for cardiovascular prophylaxis and assess the impact of a pharmacist intervention on its use. METHODS Quasi-experimental study in a community pharmacy in Palmera (Valencia), Spain. The study was conducted from November 2007 to January 2008. RESULTS Participants twenty of the 58 type 2 diabetic patients selected, fifteen (51.7%) used at the beginning antiplatelet therapy. Only one patient (11.1%) received no antiplatelet for secondary prevention, primary prevention while using seven (35%). As for not using Ten met the criteria established in the clinical practice guidelines for initial use and underwent surgery. After the intervention, three patients started using antiplatelet. CONCLUSIONS In this small group of diabetics, the use of antiplatelet agents is not overextended after the intervention increase

Intervención farmacéutica sobre el uso de antiagregantes plaquetarios en diabéticos tipo 2

OBJETIVOS Medir la prevalencia de pacientes diabéticos tipo 2 que utilizan terapia antiagregante plaquetaria como profilaxis cardiovascular y evaluar el efecto de una intervención farmacéutica sobre su uso. MÉTODOS Estudio cuasiexperimental en una farmacia comunitaria en Palmera (Valencia), España. El estudio fue realizado desde noviembre de 2007 a enero de 2008. RESULTADOS Participaron veintinueve de los 58 pacientes diabéticos tipo 2 seleccionados, quince (51,7%) usaban terapia antiagregante al principio. Sólo un paciente (11,1%) no recibía antiagregante como prevención secundaria, mientras que en prevención primaria usaban siete (35%). En cuanto a los que no usaban, diez cumplían con los criterios establecidos en las guías de práctica clínica para iniciar su uso y fueron intervenidos. Tras dicha intervención, tres pacientes comenzaron a usar antiagregante. CONCLUSIONES En este reducido grupo de diabéticos, el uso de antiagregantes plaquetarios no se encuentra excesivamente extendido, tras la intervención un mayo

Comparison of the white-coat effect in community pharmacy versus the physician's office: The Palmera study

The aim of this study was to measure the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients and to compare its magnitude with the WCE in the physician's office (POWCE). This cross-sectional study attempted to cover the treated hypertensive population, of more than 18 years of age and users of a rural CP located in Palmera (Valencia, Spain). Blood pressure (BP) was measured at three different settings, according to clinical guidelines: CP (three visits), PO (three visits), and home (4 consecutive days). The WCE was defined as the difference between the average CPBP or the average PO BP and the average home BP: CPWCE and POWCE, respectively. Differences between BP measurements were assessed by paired t-tests. The study sample consisted of 70 patients. The CPWCE was not significant, both for systolic BP (SBP) and for diastolic BP (DBP): 1.4 mmHg [standard deviation (SD): 11.3; 95% confidence interval (CI): -1.3 to 4.1] and -1.1 mmHg (SD: 7.5; 95% CI: -2.9 to 0.7), respectively. The POWCE was positive and statistically greater than 0 for SBP [13.3 mmHg (SD: 11.5); 95% CI: 10.5-16.0] and for DBP [2.4 mmHg (SD: 9.3); 95% CI: 0.2-4.6]. Finally, the POWCE was greater than the CPWCE both for SBP and for DBP (P<0.001). In this sample of treated hypertensive patients, the CPWCE was not statistically significant and was statistically lower than the POWCE. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Agreement between community pharmacy, physician's office, and home blood pressure measurement Methods : the palmera study

Background The usefulness of the community pharmacy blood pressure (BP) (CPBP) method in assessing the effectiveness of antihypertensive treatment has not been adequately studied. The aim of this study was to assess the agreement between community pharmacy, home, and physician office BP (POBP) measurement Methods in treated hypertensive patients. Methods BP was measured at the pharmacy (three visits), at home (4 days) and at the physician office (three visits). The Lin correlation-concordance coefficient (CCC) was used to evaluate the quantitative agreement. The qualitative agreement between Methods to establish the patient's hypertensive state was evaluated using the-coefficient. Using home BP (HBP) monitoring as the reference method, the sensitivity, specificity, positive and negative likelihood ratios of the CPBP and POBP measurement Methods were calculated. Results The study included 70 patients. Agreements were acceptable-moderate between CPBP and HBP (CCC (systolic BP (SBP)/diastolic BP (DBP)) = 0.79/0.66; = 0.56), moderate between CPBP and POBP (CCC = 0.57/0.61; = 0.35), and moderate-poor (CCC = 0.56/0.49; = 0.28) between POBP and HBP. The sensitivity, specificity, positive and negative likelihood ratio for the CPBP and the POBP measurement Methods were: 60.7%, 92.9%, 8.5, 0.4 and 75.0%, 54.8%, 1.7, 0.5, respectively. Conclusions In this sample of treated hypertensive patients, the agreement between the community pharmacy and HBP measurement Methods was acceptable-moderate and greater than other agreements. The CPBP measurement method was more reliable than the POBP measurement method for detecting the presence of both uncontrolled and controlled BP and could be a good alternative to HBP monitoring when the latter lacks suitability. © 2012 American Journal of Hypertension, Ltd

Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study

Objective: To determine whether age, gender, body mass index (BMI), community pharmacy blood pressure (CPBP), daytime ambulatory BP (ABP) variability, treatment compliance, number of anti-hypertensive drugs and smoking status are factors associated with the community pharmacy white-coat effect (CPWCE) in treated hypertensive patients. Setting: Eight community pharmacies in Gran Canaria, Spain. Method: A cross-sectional study was carried out from June 2008 to June 2009. The study included treated hypertensive patients older than 18 years. Patients were excluded if: systolic BP (SBP)/diastolic BP (DBP) C200≥110 mmHg, not-recommended or unable to perform home BP measurements, changes in anti-hypertensive treatment<4 weeks, history of cardiovascular disease<6 months or pregnancy. Blood pressure (BP) was measured by a community pharmacist at 4 visits to the community pharmacy and using ABP monitoring (24 h). Main outcome measure: The CPWCE was calculated as the difference between the mean BP in the community pharmacy and daytime ABP. Independent predictors of the CPWCE were identified using multivariate linear regression analysis. Results: Two hundred thirteen patients agreed to participate in the study. After exclusion and withdrawal, 169 patients were included in the analysis. Multiple linear regression analysis for systolic CPWCE revealed only community pharmacy SBP as an independent factor (β = 0.35; P<0.001). The regression analysis for diastolic CPWCE revealed female gender (β = 4.88; P<0.001), BMI (b = 0.48; P<0.001) and community pharmacy DBP (b = 0.24; P<0.001) as independent determinants. Conclusion: In this sample of treated hypertensive patients, factors such as gender, community pharmacy DBP andBMI were positively associated and may exert an important influence on the magnitude of the diastolic CPWCE. On the other hand, the CPWCE on SBP increased as the community pharmacy SBP increased. © Springer Science+Business Media B.V. 2011