The results were that pharmacists achieved the greatest improvements, followed by community health workers. The authors believe that, unlike in the government-controlled medical environment, especially if patients are subsidized or free under the Affordable Care Act, doctors and nurses don't spend much time, while pharmacists and community health care workers have calmer, more empathetic demeanors.
All of the approaches work, anything was better than nothing, but pharmacist-led interventions reduced systolic blood pressure by 7.3 mmHg and community health workers saw a 7.1 mmHg drop. Interventions led by nurses and pharmacists saw between a 2-3 mmHg reduction in systolic blood pressure. Pharmacist- and community health worker-led interventions also saw the greatest declines in diastolic blood pressure. According to current guidelines, hypertension is diagnosed at 130/80 mm Hg and higher for adults.
Dosing matters and patients in the US who are using Obamacare struggle to get an appointment, if they can get on the list to be a patient for an MD at all. Going back multiple times may not only be a hurdle getting into see a doctor, they may have trouble getting time off from work. That is where pharmacists or community health care workers can help more. Doctors in a neighborhood won't even give out their phone number to neighbors while community health care workers are part of the community. Because hypertension is a risk factor for a risk factor for a disease, there are no symptoms and less pressure-filled conversations with someone people trust likely help patients stay compliant without telling them to take medicine or they will have a heart attack.
“Blood pressure can require more time to manage than is often available in primary care visits,” said lead author Katherine Mills, associate professor and vice chair of epidemiology at Tulane University School of Public Health and Tropical Medicine. “Having someone lead an effort who doesn’t have the same time constraints may be the most effective approach.”
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