Vanderbilt University Medical Center has been funded by the Patient-Centered Outcomes Research Institute (PCORI) to implement a team-based, primary care approach to controlling high blood pressure or hypertension.
Nearly half of adults in the United States have high blood pressure (48.1%), defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg, according to the Centers for Disease Control and Prevention. Only about one in four of these individuals has their blood pressure under control (22.5%).
Alarmingly, about 34 million adults who meet clinical guidelines for hypertension either lack a prescription or are not consistently taking their prescribed medications. Almost two out of three of this group (19 million) have a blood pressure of 140/90 mmHg or higher, putting them at significant risk for heart attack, stroke and kidney damage. This project will implement findings from a PCORI-funded study comparing clinic-based and telehealth models for controlling hypertension, leveraging evidence-based strategies to enhance patient care.
“This award will further strengthen hypertension management efforts across all 38 Vanderbilt Health adult primary care practices, aligning with existing Medical Center initiatives,” said William Martinez, MD, MS, associate professor of Medicine, co-principal investigator for the project. “We estimate engaging more than 1,600 primary care patients through a pharmacist-led, team-based care intervention while also benefiting an additional 21,000 patients with uncontrolled hypertension through other EHR [electronic health record]-based management tools.”
Set to launch in August, the four-year project will involve primary care practitioners referring patients with moderately severe uncontrolled hypertension (greater than or equal to 150 mmHg/greater than or equal to 95 mmHg) to clinical pharmacists for targeted, evidence-based management. Referral of high-risk patients with chronic kidney disease, diabetes or cardiovascular disease will be encouraged.
Participating patients will have telehealth visits with the pharmacists which will include medication adherence assessments; therapeutic lifestyle counseling; medication titration; and home blood pressure monitoring. These pharmacist-led telehealth visits will take place over a 12-week period which is a critical window for achieving significant blood pressure improvements.
“A key component of this project is multilevel stakeholder engagement, which has been shown to improve delivery and effectiveness of health interventions. Health system leaders and clinicians helped shape the intervention and implementation plan and will remain involved throughout the project,” said co-principal investigator Sunil Kripalani, MD, MSc, professor of Medicine and Health Policy, vice president for Health System Sciences and director of the Center for Health Services Research.
“Primary care practitioners and pharmacists will provide input on the development of EHR tools and feedback reports, while patients and community members will contribute to all patient-facing elements. We look forward to seeing the impact of this team-based approach on patient outcomes.”
Other core members of the research team include Erin Neal, PharmD, MMHC; Henry Domenico, MS; Ben French, PhD; and Robyn Tamboli, PhD.
VUMC is a participant in PCORI’s Health Systems Implementation Initiative (HSII) and was selected for funding through a PCORI funding opportunity recruiting HSII participants to translate research findings into real-world practice. At VUMC, the HSII is co-led by Kripalani and Jenny Slayton, DNP, RN, Senior Vice President for Quality, Safety and Risk Prevention.
HSII aims to speed the translation of research evidence into practice. This initiative recognizes that health systems’ practical experience and real-world insights are crucial for sustainable, large-scale implementation of practice-changing findings in clinical care.
This funding award has been approved pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.
PCORI is a nonprofit organization with a mission to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions.
