Real-world effectiveness in hypertension and hyperlipidemia collaborative management between pharmacies and primary care in Portugal: a multicenter pragmatic controlled trial (USFarmácia®)

• Published in: International journal of environmental research and public health Vol. 20; no. 15; p. 6496
• Main Authors: Costa, Suzete, Biscaia, José Luís, Horta, Maria Rute, Romano, Sónia, Guerreiro, José, Heudtlass, Peter, Cary, Maria, Romão, Mariana, Teixeira Rodrigues, António, Miranda, Ana, Martins, Ana Paula, Bento, Ana Sofia, Pereira, João, Mateus, Céu, Helling, Dennis K.
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI 01.08.2023; MDPI AG
• Subjects: Cluster analysis; Collaboration; Collaborative; Community pharmacy; Drug stores; Effectiveness; Electronic health records; Hyperlipidemia; Hypertension; Pharmacists; Pharmacy services; Primary care; Public health interventions; Trial; United States > US; Portugal; effectiveness; real-world; hyperlipidemia; pharmacy services; public health interventions; collaborative; primary care; community pharmacy; hypertension; trial
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph20156496

Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). There is evidence of the efficacy of collaborative health interventions with pharmacies and primary care providers but little of its real-world effectiveness. We aimed to assess the effectiveness and discuss the design and challenges of hypertension and hyperlipidemia management between pharmacies and primary care providers using real-world data exchange between providers and experimental bundled payment. This was a pragmatic, quasi-experimental controlled trial. We collected patient-level data from primary care prescription claims and Electronic Medical Record databases, a pharmacy claims database, and patient telephone surveys at several time points. The primary outcomes were changes in blood pressure and total cholesterol. We used matched controls with difference-in-differences estimators in a Generalized Linear Model (GLM) and controlled interrupted time series (CITS). We collected additional data for economic and qualitative studies. A total of 6 Primary Care Units, 20 pharmacies, and 203 patients entered the study. We were not able to observe significant differences in the effect of intervention vs. control. We experienced challenges that required creative strategies. This real-world trial was not able to show effectiveness, likely due to limitations in the primary care technology which affected the sample size. It offers, however, valuable lessons on methods, strategies, and data sources, paving the way for more real-world effectiveness trials to advance value-based healthcare. This trial was promoted by the Agrupamento dos Centros de Saúde (ACeS) (NHS Group of Primary Care Units) of the Baixo Mondego Region and the Associação Nacional das Farmácias (ANF) (Portuguese National Association of Pharmacies) and was funded by the ANF. Hartmann supplied blood pressure monitors to intervention pharmacies. Trial Registration Number: ISRCTN13410498. S.C. paid for the open-access publication fee for this manuscript.