Molly Brown House Museum

Objective: A novel locally appropriate hypertension management model of care was developed and tested in the Republic of Ghana to address specific socioeconomic and community-related barriers to blood pressure (BP) control. Design and Methods: Patients with a history of hypertension were enrolled and each agreed to visit a participating nearby community pharmacy at least once per week for 6 months for a BP check, symptom review, and medication monitoring. Weekly pharmacy visit data were manually logged into a mobile application by the pharmacy staff. Guideline based logic in the application provided immediate feedback to the patient and transmitted data to the primary physician. Electronic prescriptions, from the primary physician, were accessible to participating pharmacies. Clinic blood pressure from the prior 6 months was also retrieved from patient records. Results: Compliance with weekly BP assessments in the 150 enrolled patients (57± 8 years; 73% Female) was 61% and 2705 total pharmacy BP assessments were conducted. Improvement in overall health awareness was reported in 82% of the patients and 95% indicated a desire to continue using the model of care in the future. During the 6-month voluntary program period, the number of scheduled office visits decreased by 60% compared to standard monthly visits. Despite fewer in clinic visits, average systolic BP decreased significantly from the 6-month pre-trial period baseline (137.4±14.0 to 129.8± 16.3 mmHg, p<0.01). The proportion of patients with blood pressure below target (140 mmHg) for least 75% of all readings increased from 41% in the 6 months prior to enrollment to 62% during the study follow up period (p<0.01). This improvement was associated with potential cardiovascular risk reduction of 5-21% based on previous randomized trials. The proportion of patients with > 75% controlled BP also improved in the subset of patients with BP below target at enrollment from 52% to 76% (p<0.01), implying potential risk benefits even in “well controlled” patients. Conclusions: The care model applied in this hypertensive West African resulted in fewer clinic visits and high patient and clinician satisfaction as well decreased systolic blood pressure and increased proportion of time with controlled blood pressure.