Including pharmacists in portopulmonary hypertension (PPHTN) care can help postpartum women at risk of persistently elevated blood pressure (BP), according to a recent poster presented at the American Society of Health-System Pharmacists 2023 Midyear Clinical Meeting and Exhibition.
Takeaways
- The study emphasizes the positive impact of including pharmacists in the care of postpartum women at risk of persistently elevated blood pressure, particularly in cases of portopulmonary hypertension (PPHTN).
- With 1 in 10 pregnancies presenting with hypertensive disorders, there is a significant risk of postpartum readmission. Traditional management by on-call maternal-fetal medicine or obstetric physicians may be impractical for rapid titration of antihypertensive therapy.
- The study introduces an interpersonal model for PPHTN care, involving collaboration between obstetric nurses and ambulatory care pharmacists. This model includes remote blood pressure monitoring and in-clinic evaluations for high-risk patients.
- The outcomes of pharmacist involvement in PPHTN care include successful management of patients, evidenced by 55 e-consults and 54 prescriptions within the first 3 months. Nifedipine was the predominant prescription (92.6%), indicating a practical approach to medication management.
- The results demonstrate the feasibility of integrating pharmacists into PPHTN management, with pharmacists reporting moderate to high comfort levels in various aspects, such as revising dosing instructions, implementing tip sheets, developing workflows, and incorporating blood pressure trends in e-consults.
One in 10 pregnancies present with hypertensive disorders, which leads to greater risk of postpartum readmission. Hypertension disorders are often managed by on-call maternal-fetal medicine or obstetric (OB) physicians, which the poster stated makes, “rapid titration of antihypertensive therapy impractical.”
To determine the efficacy of an interpersonal model for PPHTN care, investigators conducted a study evaluating a quality improvement to pilot pharmacist collaboration for PPHTN. Participants included patients at high risk of PPHTN receiving remote BP monitoring.
Patients with a BP above 140/90 received an initial assessment from an OB nurse. Clinicians recommended patients with cardiovascular risk factors or a BP over 160/110 receive an in-clinic evaluation.
Ambulatory care pharmacists evaluated patients with a BP of 140 to 159 over 90 to 109. Antihypertensive therapy administration was determined by symptoms, current medications, adherence, allergies, and BP readings.
Outcomes evaluated included number of patients managed by pharmacists, time spent on chart review, time to completion of e-consults, number of prescriptions generated, comfort level of pharmacists, and clinical time allotted by pharmacist.
There were 55 e-consults and 54 prescriptions within the first 3 months after e-consult implementation. Nifedipine made up 92.6% of prescriptions and labetalol 7.4%. The average durations of chart reviews and e-consults were 12.5 and 54 minutes, respectively.
Pharmacists reported PPHTN management comfort using a 10-point Likert scale, with most reporting a moderate to high comfort level. This comfort was expressed for revising dosing instructions, implementing a weekly tip sheet, developing a workflow, and including BP trends in the e-consult.
These results indicated feasibility for integrating pharmacists into PPHTN management, allowing initiation of antihypertensive medications to target postpartum women with increased risk of high BP. Investigators concluded this model of care enables quality care delivery and improved access.
Reference
Safri A, Yarrington C, Kopcza B, Cohen S, Norman K. Implementation of an interprofessional electronic consult for the management of postpartum hypertension (PPHTN). Presented at: the American Society of Health-System Pharmacists 2023 Midyear Clinical Meeting and Exhibition, Anaheim, CA.
