Effect of Pharmacist Home Visits on Weight Control in Overweight Elderly Hypertensive African American Patients: Managing Your Blood Pressure (My Bp) Program.

OBJECTIVE: The objective was to investigate the effect of a home-based pharmacy intervention on body mass index (BMI) in a cohort of older hypertensive overweight African American (AA) patients. DESIGN: A secondary analysis of data collected in a community-based intervention study. SETTING: Community-based. PARTICIPANTS: AA patients, ≥ 65 years old, residing independently, with hypertension diagnosis and BMI ≥ 25. INTERVENTIONS: During a 6month period, patients received 1) two in-home pharmacist-led consultations on weight management, 2) bi-weekly telephone counseling, and 3) health education strategies. MAIN OUTCOME MEASURES: BMIs at baseline and 6 months; stages of behavioral change in diet and exercise based on the Transtheoretical Model. RESULTS: At baseline and 6-month follow-up, a total of 153 participants had BMI ≥ 25 and received a completed assessment of behavioral stages. Participants' mean age was 74.2 years. A reduction of BMI from 31.7 (obese) at baseline to 29.8 (overweight) at 6-months (p=0.0008) was observed. For every stage of improvement in diet, there was a reduction of 1.24 points in BMI (p=0.008). For every stage of progress in exercise, there was a reduction of 0.77 points in BMI (p=0.013). CONCLUSION: Pharmacists-led in-home consultations coupled with telephone follow-ups and health education strategies may improve lifestyle and lower BMIs in this cohort. Further studies are needed to investigate these strategies on weight management in geriatric patients with chronic illnesses.

Implementation of a medication adherence program in senior public housing facilities utilizing pharmacists and health educators.

BACKGROUND: Hypertension and diabetes disproportionately impact people of color when compared to majority populations. Medication adherence among seniors with chronic diseases has been suboptimal with the estimation that only half of those taking antihypertensives are adherent. Therefore, the purpose of The Managing Your Medications (MY Rx) program was to evaluate the effectiveness of evidence-based practices used to improve rates of medication adherence through information dissemination among diabetic and hypertensive African American, Asian American, and Hispanic residents housed in senior public housing facilities in the Greater Houston Area. The program comprised an 8-week intervention with individual and group components with small incentives provided throughout the program. Individual components included one home visit and telephone consultations conducted by pharmacists. Health educators provided two group education sessions on lifestyle modifications. RESULT: Qualitative analysis of focus group discussions revealed participant satisfaction with the MY Rx program and willingness to change after participation in the program. CONCLUSION: The Rx program showed the potential effectiveness of an innovative strategy in medication counseling using interdisciplinary pharmacists and health educators to promote health. It demonstrated the importance of using the patient-centered care framework in designing a community intervention program.

Managing Medication Adherence in Elderly Hypertensive Patients Through Pharmacist Home Visits.

OBJECTIVE: The purpose of the Managing Your Blood Pressure program was to reduce health disparities in blood pressure (BP) control by improving medication adherence in a cohort of geriatric African-Americans with hypertension (HTN). DESIGN: The program was implemented using a quasi-experimental pre- and postintervention study design that utilized a pharmacist home-based model and follow-up educational phone calls to impact BP over a six-month period. SETTING: Home visits occurred in participants' residences, and phone calls occurred at program headquarters at Texas Southern University (Houston, Texas). MAIN OUTCOME MEASURES: The primary outcome measure was BP control rate, and secondary outcome measures were knowledge of HTN, medication adherence, and use of a BP monitor. RESULTS: At six months, 306 of the 431 patients recruited completed all phases of the program (two in-home consultations and biweekly telephone consultations). At the end of the six-month intervention period, the reduction in mean systolic BP was statistically significant (baseline 140 mmHg vs. six months 137 mmHg; P < 0.049). No difference in mean diastolic BP pre- and postintervention was found. The percent of patients with controlled BP improved from 46.7% to 49.5%; P = 0.34. Medication adherence, self-monitoring of BP, and knowledge of HTN were significantly improved from baseline to postintervention. CONCLUSION: Pharmacist-led interventions in the home were effective in improving BP control and medication adherence. Further programs are needed to address uncontrolled HTN in this vulnerable population.