Key DFM Personnel

Beth Potter, MD – Principal Investigator

Funding

NIH/National Heart, Lung and Blood Institute

Summary

The objective of this study is to conduct a large, multi-center trial to determine the extent to which physician-pharmacist collaborative management (PPCM) of chronic disease states will be adopted in clinics with geographic, racial and ethnic diversity. Wingra Family Medicine Clinic is one of 27 clinics across that country that has been randomized to one of 3 study arms. This study arm enrolls patients for two groups: Hypertension Usual Care and Asthma PPCM Intervention.

Goal

The specific aims of this study are to (1) determine if patients in clinics randomized to PPCM for HTN can achieve better blood pressure (BP) control at 9 months compared to patients in clinics randomized to the control group, and 2) determine if patients in clinics randomized to PPCM for HTN can achieve better long-term BP control compared to patients in clinics randomized to the control group. The objective of the asthma study is to determine whether PPCM for asthma management can improve outcomes for patients with asthma.

Methodology

Clinics were stratified based on pharmacist structure survey scores and percent minority population. After stratification, clinics were randomized into one of three study arms: 1) BP PPCM Intervention, 2) BP PPCM Extended Intervention, or 3) Asthma PPCM Intervention / BP Usual Care (Wingra Family Medicine Clinic, Madison).

Patients in the Active Observation Groups in clinics randomized to BP PPCM Intervention will receive pharmacist/physician collaborative management of hypertension for 9 months and will be followed by the research coordinator for a total of 24 months. Patients in clinics randomized to BP PPCM Extended Intervention will receive pharmacist/physician collaborative management of hypertension for 24 months. Patients in clinics randomized to Asthma PPCM Intervention / BP Usual Care will receive usual care from their physician for 24 months. Comparison of blood pressures between study arms at 9 months will determine the impact of BP PPCM compared to usual care. Comparison of blood pressures between study arms at 24 months will help determine if there is a lasting effect of BP PPCM on blood pressure and if continuation of BP PPCM is necessary to maintain blood pressure control.

In addition to the active observation group, a group of hypertension patients will be assigned to an observational cohort Passive Observation Group (POG) to determine whether study activities, or the PPCM intervention, spread to clinic subjects who are not consented into the study and who are not enrolled in the study. The endpoint used to measure this question will be clinic BP measurements abstracted from medical records of subjects assigned to the Passive Observation Group. The identification of the passively observed subjects will not begin until after the first active observation subject has been enrolled for two years (year 2013). Electronic Health Records will be used to abstract 24 months of data on the 9 POG subjects at Wingra Family Medicine Clinic in Madison and 486 patients nationwide.