Designing and Implementing a Cost-effective TEAM Hypertension Service in Pharmacies: Building on Tools and Lessons from the Wisconsin TEAM Trial

Many hypertension patients do not adhere to their drug regimens and blood pressure (BP) remains poorly controlled in many countries. Studies demonstrate that pharmacists can improve adherence and BP control. However, most BP interventions are long in duration (O12 months), require multiple visits and professional time (60 minutes/ initial visit, 30 minutes per follow-up visit), lack sustained effects after intervention discontinuation, lack testing in minority populations, and have not been implemented widely in busy pharmacies where staff lack brief tools for quickly and efficiently monitoring and facilitating adherence, BP control, and feedback to patients and physicians. To address these issues, we designed and evaluated a “systems intervention” for pharmacy staff and African-American patients in typical pharmacies. Our intervention is called the Team Education and Adherence Monitoring (TEAM) model and includes: 1-day training for one pharmacist and 1-2 technicians per pharmacy; distribution of novel toolkits for quickly and efficiently monitoring and facilitating adherence, BP control, and pharmacist feedback to patients and physicians; and modest compensation for interventions. The TEAM toolkits include: tools for brief assessment and tracking of hypertension patients and barriers to adherence; brief tools for increasing patient awareness and feedback to physicians; and brief tools for documenting interventions, plans, and time spent. Toolkits were designed to achieve high “intervention fidelity”(extent to which pharmacy staff actually implement intervention as intended). Blinded project assistants screened 1250 African-American patients at 28 pharmacies in the cluster-randomized Team Education and Adherence Monitoring (TEAM) trial. Of those screened, 576 had treated but uncontrolled hypertension and were eligible for a 6-month intervention. TEAM patients met monthly with a pharmacist technician team using TEAM tools; patients at control pharmacies received printed information only. Outcomes were assessed using refill records, surveys, and blinded BP measurements at baseline, month 6 (end of intervention), and month 12 (6 months after discontinuation). Results showed good intervention fidelity and sustained improvements in refill adherence and systolic BP. Aims of workshop: Aims are to: 1) briefly describe core elements, intervention tools, and strategies for achieving “intervention fidelity” by pharmacy staff; 2) provide an overview of intervention outcomes, costs, and fidelity results; and 3) stimulate discussion about how others might apply a TEAM approach within a Medication Therapy Management (MTM) program or other environment or health system. Learning Objectives: After workshop, participants will be able to: 1) describe how to access and implement at least 1-2 TEAM tools for improving adherence, BP control, and teamwork in typical pharmacies and other environments and 2) describe at least one opportunity for improving hypertension care in other environments. Workshop Activities: The workshop includes: 25-minute presentation (with QA 25-minute presentation (with QA and 40-minute open discussion about whether/how to apply or build on a TEAM approach in other environments and opportunities for improving hypertension care worldwide. Additional information: Organizers will need a PowerPoint projector and 4 flipcharts.