Pharmacist-Run Pill Box Clinics Improve Adherence to Antihypertensive Medications

Pill box clinics conducted by pharmacists improve drug adherence among patients with uncontrolled hypertension who receive multiple antihypertensive medications, according to a recent study published in the Journal of Managed Care & Specialty Pharmacy.

For the study, Angela K. Porter, PharmD, CDE, BCACP, a clinical pharmacy specialist for the Charles George VA Medical’s Pharmacy Service Center in Asheville, North Carolina, and her coauthors enrolled 60 veterans with a medication regimen comprised of 3 or more antihypertensive drugs. All study participants were diagnosed with hypertension for at least 1 year and had 3 consecutive systolic blood pressure (BP) readings above target levels, defined as <130/80 mm Hg for those with diabetes and <140/90 mm Hg for all other patients.

“Of patients receiving antihypertensive treatment, 50% discontinue therapy, and of those that remain on therapy, approximately half are >80% adherent to antihypertensive medications,” the study authors noted.

Under the supervision of a pharmacist, each patient was provided with a pair of 7-day pill boxes to organize all of their antihypertensive medications. The patients filled the pill boxes with their own medications, which were verified by the pharmacist using electronic medical records. Thereafter, the patient or caregiver was responsible for organizing the medications.

At 2 and 4 weeks, the patients attended 2 additional follow-up appointments for refills of pill boxes, BP measurements, and adherence assessments. Of the participants, 50 completed the baseline and second appointment, while 45 attended all 3 appointments. Of the latter group, 24% and 31% recorded at least a 10 mm Hg reduction in systolic BP between the second and third appointments, respectively. However, the BP readings during each of the 3 appointments were not statistically different.

“Although results were not statistically significant, the pill box clinic resulted in clinically significant reductions in systolic BP by 10 mmHg, as well as an increased number of patients meeting prescribed BP goals,” Dr. Porter and her coauthors concluded. “The findings from this pre-/post-prospective study suggest BP goals are more likely to be met when antihypertensive medications are organized in a pill box, and use of the pill box is monitored by a pharmacist.”

In addition to enhancing medication adherence among patients with uncontrolled hypertension in the current trial, pill box clinics have previously demonstrated similar results among patients who receive antiretroviral or anticoagulation therapies.