Before-after Comparison of Physician/pharmacist Collaborative Drug Therapy Management to Traditional Care in Pediatric Hypertension: Interim Analysis

Background: Pediatric hypertension is a condition that affects 2-5% of children and adolescents and is frequently underdiagnosed and under-treated. This problem may be worse in rural communities affected by disproportionate shortages of pediatricians and pediatric subspecialists. Pharmacists can work with physicians to engage in collaborative drug therapy management (CDTM) and reduce burdens on overloaded physicians. This project was designed to evaluate a physician-pharmacist collaborative practice in mostly rural northeast Louisiana.

Methods: This study was conducted at a single pediatric cardiology clinic and compared one year of CDTM (2020) to one year of traditional care (2018) for: control of hypertension at 3 and 6 months and time to control of hypertension.

For inclusion, patients had to be 4-20 years old at enrollment, referred to CDTM (prospective) or treated at the cardiology clinic for hypertension (retrospective), and had to attend at least two visits with pharmacist or physician during the study period. Hypertension control was defined as a mean visit blood pressure of less than the 95th percentile for age, sex, and height in children or less than 130/80mmHg in adolescents. Time to control of hypertension was measured from the first visit with uncontrolled blood pressure until the first visit with controlled hypertension. Control of hypertension at 3 and 6 months was achieved if participants met their goal blood pressure by and sustained it until 3 and 6 months from the first visit with uncontrolled blood pressure. A noninferiority margin of δ=20% was sought.

Results: Fifty-three patients aged 4-20 were seen during 2018 (traditional care) and 89 during 2020 (CDTM). Of those patients, 27 and 52 met inclusion criteria respectively; the most common reason for exclusion was failure to follow-up with physician or pharmacist during the study period. At 3 months, 4/27 patients in traditional care and 15/52 patients in CDTM had controlled hypertension (OR: 2.33, CI: 0.689 - 7.89). At 6 months, 2/8 patients in traditional care and 8/13 patients in CDTM had controlled hypertension (OR: 2.46, CI: 0.414-14.6). Median time to control for traditional care was 62 days [IQR: 28.5 - 90.5] compared with 57 days [IQR: 36.5 - 97.5] for CDTM.

Conclusion: Although hypertension control was higher in the CDTM group, results did not meet criteria for noninferiority. The CDTM group had more patients, and the traditional care group had a higher proportion of patients without a second visit. Time to control was similar between groups. Our data are underpowered, but we expect that our final analysis will provide more definitive results.