Evaluation of pharmacist prescriber clinic for hypertension

Hypertension is a key risk factor for cardiovascular disease. The incidence of hypertension on GP registers is 13.9 per cent, and yet it is reported in the literature that 30–50 per cent of patients still have uncontrolled blood pressure levels. Given the increasing pressure on GP services, our researchers wanted to determine whether utilising the skills of a pharmacist prescriber to manage patients with hypertension could facilitate medicines optimisation in this cohort

A two-hour weekly pharmacist prescriber clinic was introduced in one GP surgery in Brighton for a six month period to evaluate the feasibility of this service. The GP practice and the project group agreed guidelines in line with NICE/British Hypertension Society and a scope of practice for a pharmacist prescriber in hypertension. The initial referral of patients to the clinic was made by practice staff with subsequent appointments booked by the pharmacist.

The aim of the project was to evaluate whether a regular, weekly clinic conducted by a pharmacist prescriber to manage patients with hypertension could have a positive impact on medicines optimisation.

Over the six month period, 64 patients were invited to attend and 117 appointments were made in the pharmacist clinic. The attendance rate was 89.8 per cent. The age of the patients ranged from 38–93 years with a mean age of 70.3 years.

Referrals included patients:

already prescribed at least one medicine for hypertension but whose blood pressure was not controlled (n=58)
with a new diagnosis of hypertension (n=2)
requiring monitoring due to postural hypotension concerns (n=3)
with a change of regime due to a new diagnosis of heart failure (n=1).
Patients attended between one and five clinic appointments.

The service was well received by the patients who expressed satisfaction with the continuity of service and the staff at the GP surgery who particularly liked the independent prescribing aspects.

At the end of the project, 55 per cent of the patients had been discharged as blood pressure targets had been achieved. The success of the project was limited by the time frame as optimisation was not complete for referrals to the clinic towards the end of the six-month period.

The pilot study clearly demonstrated the feasibility of pharmacist prescribers in the management of hypertension. In this clinic, patients were booked by practice staff. An ongoing clinic targeting high risk patients should be undertaken to maximise the benefits on patient outcomes.