Pharmacist-CHW Team to Improve Medication Adherence and Reduce Hypertension Disparities

Abstract The U.S. faces profound racial and ethnic disparities in hypertension, which are exacerbated by disparities in medication adherence. Yet few existing medication adherence interventions are tailored to address the specific cultural beliefs of diverse populations who also face significant structural barriers to adherence associated with poverty, access to care and food insecurity. The proposed Improving Medication Adherence with Pharmacist and CHW Team (IMPaCT) intervention responds to the call for adherence interventions that are tailored for the specific needs of minority racial-ethnic groups. IMPaCT is a practice-based randomized controlled trial (RCT) to test the effectiveness of a comprehensive, individually- and culturally-tailored intervention for high-risk patients with hypertension, polypharmacy and low adherence. IMPaCT leverages the specialized expertise of a clinical pharmacist together with a community health worker (CHW) who will serve as cultural broker and patient navigator to address individual, clinical, social-cultural, and structural barriers to adherence. This comprehensive and tailored, coordinated care intervention aims to improve medication adherence and hypertension outcomes among African-American, Latino and Vietnamese immigrant patients. The proposed practice-based RCT is designed to meet the following specific aims: Aim 1: Implement IMPaCT, an innovative, tailored adherence intervention delivered by a pharmacist and CHW team. Aim 2: Determine the short- and long-term effectiveness of IMPaCT by assessing pre- to post-intervention changes in: a) medication adherence (proximal outcome) and blood pressure (BP, distal outcome), and b) other comorbid health outcomes (e.g., HbA1c, BMI) using a randomized controlled trial. Aim 3: Identify factors associated with IMPaCT effectiveness including: a) tailored intervention features, b) medication beliefs, c) barriers to adherence, d) intervention dose, e) health literacy, and f) cultural group. We will follow an intention-to-treat randomized design using a waitlist control with 450 African-American, Latino, and Vietnamese patients with hypertension and low (<80%) medication adherence. Data collection via pill count, self-report, the electronic health record, and clinical measures will assess medication adherence, BP and other factors at baseline (pre-intervention) and at 4, 10, and 24 weeks post-intervention. IMPaCT is an innovative coordinated care team intervention to improve medication adherence and blood pressure derived from research findings that builds on existing clinical practice. Designed with an eye towards sustainability, IMPaCT incorporates billable pharmacist and CHW services for patients with low medication adherence and high burdens of chronic illness and preventable consequences. IMPaCT offers interprofessional team care with comprehensive expertise and complementary skill sets that mitigate the silo effect of specialized medicine to deliver primary care to diverse, high-risk populations experiencing disparities in hypertension.