Comprehensive Medication Management for Hypertension in the United States: A Scoping Review of Therapeutic, Humanistic, Safety and Economic Outcomes
Year: 2025
Type: reference-entry
Abstract: Emerging research has shown that pharmacist-led comprehensive medication management (CMM) can be an effective strategy for controlling hypertension. A synthesis of the evidence on the overall effects of CMM on clinical, quality, and economic outcomes could help inform and contribute to improvements in programming and practice. Presently, such a synthesis is limited in the literature. To address this gap, we conducted a scoping review of CMM effects on these outcomes, organized by 4 domains: therapeutic, humanistic, safety and economic. Using predefined search terms for articles on studies published between 2010 and 2024, we performed a literature search utilizing these terms to search the MEDLINE, Cochrane Library and CINAHL databases. For each of the identified studies, we applied a multi-stage screening process to extract data, chart results, and synthesize findings. The process took into account methodology of study design, patient population involved, CMM implementation, relevance of outcomes to clinical improvement, and factors that were deemed relevant to study selection. In total, 49 experimental, observational, and simulation-based studies were included in the scoping review. The synthesis focused on outcomes most frequently reported and those rigorously evaluated by the studies in the review. They included clinical measures of blood pressure reduction and control, frequency and duration of healthcare visits, and changes in medication therapy regimen and medication adherence. Overall, CMM interventions were found to have significantly favorable effects on systolic blood pressure reduction, hypertension control, and medication changes. Other outcomes, which showed positive effects, included self-reported patient experience and behaviors, emergency department visits, hospitalizations, mortality, and program costs and related savings from implementing a CMM program. Some results, however, were mixed. For example, a number of studies reported outcomes data without significance testing and many generally lacked consistent characterization of their programming and implementation processes. Future research and practice evaluations should include these elements in their documentation. Furthermore, a more consistent approach to implementing CMM in the field may lead to better support of program delivery fidelity, helping to optimize CMM, moving it from demonstrated efficacy to intervention effectiveness in the real world.
Source: Encyclopedia
Authors: Dalia Regos-Stewart, Noel C. Barragan, Scott Weber, Alexander Cantres, Devin Lee, Luis Larios, Evans Pope, Steven Chen, Tony Kuo
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $1,207
Awards: INNOVATIVE SOLUTIONS FOR CARDIOVASCULAR HEALTH - THE INNOVATIVE SOLUTIONS FOR CARDIOVASCULAR HEALTH (ISCH) PROJECT WILL UNITE THE LOS ANGELES DEPARTMENT OF PUBLIC HEALTH, THE COMMUNITY CLINIC ASSOCIATION OF LOS ANGELES COUNTY, THE UNIVERSITY OF SOUTHERN CALIFORNIA (USC) ALFRED E. MANN SCHOOL OF PHARMACY AND PHARMACEUTICAL SCIENCES, THE USC GEHR FAMILY CENTER FOR HEALTH SYSTEMS SCIENCE AND INNOVATION, LOCAL FEDERALLY QUALIFIED HEALTH CENTERS AND COMMUNITY HEALTH CENTERS, AND COMMUNITY-FOCUSED PARTNERS TO DEVELOP A COMPREHENSIVE, MULTI-PRONGED PROGRAM THAT WILL FACILITATE SYSTEM-LEVEL CHANGES THAT REDUCE HEALTH AND HEALTH CARE DISPARITIES BY BRIDGING GAPS IN EQUITY THAT IMPACT LOCAL COMMUNITIES MOST AT RISK FOR DEVELOPING CARDIOVASCULAR DISEASE. ISCH WILL FOCUS ITS WORK IN TWO CENSUS TRACTS WHERE THE OVERALL CRUDE HYPERTENSION PREVALENCE AMONG ADULTS IS 53% OR HIGHER, BASED ON THE CDC’S PLACES. THESE CENSUS TRACTS HAVE A HIGHER PROPORTION OF BLACK RESIDENTS, HIGHER NUMBERS OF PEOPLE EXPERIENCING HOMELESSNESS, AND HIGHER RATES OF POVERTY, WHEN COMPARED TO THE REST OF LOS ANGELES COUNTY (LAC). RESIDENTS OF THESE COMMUNITIES ARE OVER-BURDENED BY CRITICAL, SOCIAL NEEDS (E.G., LACK OF AFFORDABLE HOUSING, NEED FOR FOOD ASSISTANCE, TRANSPORTATION BARRIERS, ETC.), WHICH CAN INHIBIT THEM FROM MANAGING CHRONIC CONDITIONS, SUCH AS HYPERTENSION. WHERE FEASIBLE, ISCH WILL EXPAND THESE EFFORTS TO ALSO IMPROVE THE HEALTH OUTCOMES FOR AT-RISK INDIVIDUALS AND GROUPS FROM OTHER AREAS AND COMMUNITIES IN LAC, BASED ON HEALTH INDICATORS FROM OTHER DATA SOURCES. ISCH WILL BUILD UPON THE MOMENTUM OF THE 2014-2018 CHRONIC DISEASE PREVENTION STRATEGY (CDC 1422 INITIATIVE) AND THE 2018-2023 SOLUTIONS FOR HEALTHIER COMMUNITIES (CDC 1817 INITIATIVE) TO IMPLEMENT A TARGETED, INTEGRATED MODEL OF CHRONIC DISEASE PREVENTION AND CONTROL. ISCH WILL UNDERTAKE A VARIETY OF ACTIVITIES, SUCH AS UTILIZATION OF COMMUNITY RESOURCE REFERRAL PLATFORMS, GIS MAPPING, COALITION BUILDING, SELF-MEASURED BLOOD PRESSURE MONITORING, AND THE USE OF PHARMACISTS AND COMMUNITY HEALTH WORKERS, IN ORDER TO BETTER UNDERSTAND AND SUPPORT THE NEEDS OF TARGET COMMUNITIES. THROUGH ORGANIZATIONAL PRACTICES, HEALTH INFORMATION TECHNOLOGY, TRAINING AND TECHNICAL ASSISTANCE, AND LEVERAGING OF KEY INTERVENTIONS, ISCH INTENDS TO SCALE PROGRAMS AND DISSEMINATE BEST PRACTICES FOR INTEGRATING SOCIAL SUPPORT, HEALTH EDUCATION, AND CLINICAL CARE DELIVERY DESIGNED TO PREVENT OR CONTROL HYPERTENSION AND HIGH CHOLESTEROL WITHIN APPROVED POPULATIONS OF FOCUS. ISCH WILL ACCOMPLISH THESE GOALS BY EXECUTING THE THREE STRATEGIES OUTLINED IN DP-23-0005 NOTICE OF FUNDING OPPORTUNITY. THEY WILL BE IMPLEMENTED AT CLINIC AND COMMUNITY SITES SERVING POPULATIONS OF HIGH HYPERTENSION PREVALENCE AND DISPROPORTIONATELY AFFECTED BY FACTORS RELATED TO THE SOCIAL DETERMINANTS OF HEALTH. RESOURCES AND LESSONS LEARNED FROM IMPLEMENTING THESE STRATEGIES WILL BE DISSEMINATED AMONGST A BROAD NETWORK OF PARTNERS, SO THAT THEY MAY BE REPLICATED TO ADDRESS HEALTH DISPARITIES THROUGHOUT LAC. BY PROJECT END, THESE MUTUALLY REINFORCING STRATEGIES SHOULD RESULT IN INCREASED ACCESS TO SOCIAL SERVICES AND RELATED SUPPORTS, ENHANCED INTEGRATION OF MEDICAL AND SOCIAL SERVICE DELIVERY, AND IMPROVED BLOOD PRESSURE AND CHOLESTEROL CONTROL WITHIN THE HIGHEST BURDEN POPULATIONS IN LAC., CHRONIC DISEASE PREVENTION & MANAGEMENT STRATEGY: INNOVATIVE SOLUTIONS FOR HEALTHIER COMMUNITIES
OpenAlex ID: W4413874904