Preparing pharmacists to deliver a targeted service in hypertension management: evaluation of an interprofessional training program

Bajorek et al. BMC Medical Education (2015) 15:157 DOI 10.1186/s12909-015-0434-y RESEARCH ARTICLE Open Access Preparing pharmacists to deliver a targeted service in hypertension management: evaluation of an interprofessional training program Beata V. Bajorek1*, Kate S. Lemay2, Parker J. Magin3, Christopher Roberts4, Ines Krass5 and Carol L. Armour2 Abstract Background: Non-adherence to medicines by patients and suboptimal prescribing by clinicians underpin poor blood pressure (BP) control in hypertension. In this study, a training program was designed to enable community pharmacists to deliver a service in hypertension management targeting therapeutic adjustments and medication adherence. A comprehensive evaluation of the training program was undertaken. Methods: Tailored training comprising a self-directed pre-work manual, practical workshop (using real patients), and practice scenarios, was developed and delivered by an inter-professional team (pharmacists, GPs). Supported by practical and written assessment, the training focused on the principles of BP management, BP measurement skills, and adherence strategies. Pharmacists’ experience of the training (expectations, content, format, relevance) was evaluated quantitatively and qualitatively. Immediate feedback was obtained via a questionnaire comprising Likert scales (1 = “very well” to 7 = “poor”) and open-ended questions. Further in-depth qualitative evaluation was undertaken via semi-structured interviews several months post-training (and post service implementation). Results: Seventeen pharmacists were recruited, trained and assessed as competent. All were highly satisfied with the training; other than the ‘amount of information provided’ (median score = 5, “just right”), all aspects of training attained the most positive score of ‘1’. Pharmacists most valued the integrated team-based approach, GP involvement, and inclusion of real patients, as well as the pre-reading manual, BP measurement workshop, and case studies (simulation). Post-implementation the interviews highlighted that comprehensive training increased pharmacists’ confidence in providing the service, however, training of other pharmacy staff and patient recruitment strategies were highlighted as a need in future. Conclusions: Structured, multi-modal training involving simulated and inter-professional learning is effective in preparing selected community pharmacists for the implementation of new services in the context of hypertension management. This training could be further enhanced to prepare pharmacists for the challenges encountered in implementing and evaluating services in practice. Keywords: Hypertension, Pharmacist, Prescribing, Training, Interprofessional, Adherence Background Hypertension represents a large disease burden in Australia [1] and cardiovascular disease (CVD) is one of the Australian government’s health priority areas [2]. Although hypertension responds well to drug therapy, only 40–60 % of diagnosed hypertensive patients in * Correspondence: 1 Graduate School of Health, University of Technology Sydney (UTS), Sydney, Australia Full list of author information is available at the end of the article Australia have their blood pressure (BP) well controlled [3, 4]. This is due to a combination of suboptimal adherence to medications on the part of patients and therapeutic inertia (suboptimal adherence to guidelines) on the part of prescribers [5–7]. In hypertension, the most common non-adherent behavior of patients is discontinuation of therapy [8]. In a review of prescription claim records of nearly 50,000 randomly selected concession card-holders for the 3 years 2004 to 2006, 19 % of patients who had newly prescribed antihypertensive © 2015 Bajorek et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Bajorek et al. BMC Medical Education (2015) 15:157 medications did not collect a second prescription [8]. Compared to non-adherent patients, those who are adherent are significantly less likely to develop a cardiovascular event [9]. Community pharmacists are well positioned to address gaps in care of hypertensive patients. Targeted interventions by pharmacists have been shown to improve medicines use [10], the appropriateness of prescribing [11], and BP control in the management of hypertension [12]. Furthermore, pharmacist-led medicines review services significantly contribute to the prescribing of evidencebased therapies in cardiovascular health [13]. Australian pilot studies have also demonstrated the potential for pharmacist prescribing in hypertension management, suggesting that credentialed pharmacists are able to make appropriate therapeutic decisions [14]. However, until such services are fully realized in the Australian health care setting, the pharmacist’s expertise is best utilized currently through collaborative decisionmaking with clinicians via models of ‘shared care’. The Health Collaboration Model provides an important framework for this, optimizing the respective roles of health professionals whilst providing patient-centered care [15]. A study (funded by the National Heart Foundation of Australia) is underway to explore this within a targeted pharmacist-led service for hypertension management. To fulfill such a role, pharmacists need training in hypertension guidelines and delivery of adherence support strategies. Specially trained community pharmacists can add value to the primary health care management team in terms of medication management. Specifically, therapeutic adjustment recommendations, adherence support and monitoring can all occur in-line with regular visits to the pharmacy. The purpose of this study was to evaluate a training program designed to enable pharmacists to implement and deliver a targeted service in hypertension management. Specifically, the evaluation canvassed pharmacists’ perspectives on the format of the training program (in terms of structure, duration, quality, content) and how this related to their subsequent preparedness for service provision. Methods A training program was developed for community pharmacists who were recruited to participate in an intervention trial evaluating the impact of a targeted pharmacist-led service in hypertension management (Fig. 1; Fig. 2). The training program was evaluated at the time of training as well as after the service had been implemented (i.e., at conclusion of the intervention trial). Conduct of the stud (...truncated)