USUAL METHODOLOGY FOR BLOOD PRESSURE MEASUREMENT IN THE COMMUNITY PHARMACIES. FARMAPRES PROJECT

M. Reig Botella1, M. Córcoles Ferràndiz2, J. Amorós Mas2, E. Aura Perol2, J. Boronat Cortes2, M. Cerdá Ferre2, V. Pallarés Carratalá3, V. Giner Galvañ1


1Department of General Internal Medicine. Hospital Verge dels Lliris. Alcoy (Alicante), Spain. 2Community Pharmacist. Alcoy´s Health Department. Alcoy (Alicante), Spain. 3Sociedad Valenciana de Hipertensión y Riesgo Vascular SVHTA. SVHTAyRV. Valencia, Spain.

Objectives: To assess the usual methodology applied for the measurement of BP in the Community Pharmacies (CPh) and its validity.

Material and method: A survey with 12 questions was designed to assess the usual methodology applied for BP measurements in all the CPh of the Health Department of Alcoy, in the province of Alicante. The survey was sent by conventional as well as electronic mail to the 79 CPh of the Department.

Results: The response of 39 in 79 CPh (49.4%) was obtained, with more than 95% of the population covered. BP measurement is usually (97%) made in sitting position (3% at standing position) at the brachial level (87%), although in 13% it is made at the wrist. In spite of 39% pharmacies have specific cuff for brachial perimeter > 32 cm (“obese cuff”), only 4% measured arm circumference before BP measurement, with 8%  saying that “they no have this kind of client”. The majority of CPh made one (62%) or two (25%) consecutive BP measurements, although it is very common (76% of those with a usual unique measurement) a second measurement “after 5 minutes of rest” in the case of a “high BP” with the first measurement. It is very heterogeneous the type of tensiometer used in each CPh, with 27 different models identified. It is noteworthy the fact that in 31.1 and 2.6% of the occasions two or three different systems are used. Semiautomatic tensiometers are the mostly used (44%), with aneroid and mercury ones used in 33 and 23% respectively. Just 52% of semiautomatic tensiometers (27.6% of total tensiometers) are validated according to adbl Education Trust criteria (http://www.dableducacional.org).

Discussion: Results are in accordance with three previous studies made in Spain in Albacete and Guipúzcoa provinces and at the city of Valencia showing a correct BP measurement just in 10% of CPh.

Conclusions: It is necessary to improve methodology for BP measurement in CPh before promote their participation in the control of hypertension through the implementation of using validate measurement systems, adjustment of the cuff to the arm circumference and systematic use of repeated consecutive measurements.

Rev Clin Esp 2012; 212: 446-447

 

INTERPRETATION OF BLOOD PRESSURE VALUES OBTAINED IN A COMMUNITY PHARMACY BY THE PHARMACISTS. FARMAPRES PROJECT

M. Reig Botella1, F. Miralles López2, O. Jiménez Jiménez2, F. Gozálbez Esteve2, E. Turrión Gozálbez2, J. Tamarit García3, B. Roig Espert4, V. Giner Galvañ1

1Department of General Internal Medicine. Hospital Verge dels Lliris. Alcoy (Alicante), Spain. 2Community Pharmacist. Health Department of Alcoy. Alcoy (Alicante), Spain. 3Department of General Internal Medicine. Hospital Universitario Dr. Peset Aleixandre. Valencia, Spain. 4Department of General Internal Medicine. Hospital de Manises. Manises (Valencia), Spain.

Objectives: To study how a pharmacist take decisions depending on blood pressure (BP) measurements at the community pharmacy (CPh) on real-life conditions.

Material and method: As a part of a specific survey, participants (39 CPh, 49.4% of participation) were asked about BP values defining "Normal BP", "Uncontrolled BP" and "BP values for remission to a medical service".

Discussion: There is a very important heterogeneity interpreting BP values with very high subjective criteria. Pharmacists are stricter when considering DBP than systolic BP. This is especially true when defining "normotension" or considering values "for remission". When defining "uncontrolled BP" both components are equally considered.

Conclusions: There is a great heterogeneity and subjectivity when BP values are interpreted by community pharmacists.Probably a better specific formation could imporve the utility of CPh in the control of BP.

Rev Clin Esp 2012; 212: 450-451

 

ATTITUDES AND ACTIONS OF THE COMMUNITY PHARMACIES OF ALCOY’S HEALTH DEPARTMENT FOR THE REMISSION OF UNCONTROLLED HYPERTENSIVES TO MEDICAL SERVICES.  FARMAPRES-CV PROJECT

M. Reig Botella1, I. Llopis Boluda2, I. Ramírez Rodríguez2, M. Robles Sáez2, E. Sainz Nadales2, I. Bonig Trigueros3, C. Sánchez García2, V. Giner Galvañ1

 

1Department of General Internal Medicine. Hospital Verge dels Lliris. Alcoy (Alicante), Spain. 2Community Pharmacist. Health Departament of Alcoy. Alcoy (Alicante), Spain. 3Department of General Internal  Medicine. Hospital de Vinaroz. Vinaroz (Castellón), Spain.

Objectives: In spite of a large number of clinical guidelines for the remission of uncontrolled hypertensive patients from the community pharmacy (CPh) to medical services, nobody knows what actions are really being taken.

Material and method: Since November 2011 until February 2012, a specific survey was sent to all CPh (n = 79) of Alcoy’s Health Department, obtaining the participation of 49.4% of them.

Results: In the opinion of all participants CPh have an important very important potential for the improvement of the control of hypertension (HT). The reasons for that are expressed in table 1. When the CPh think a patient has elevated BP (very heterogeneous and subjective criteria for it), a second measurement use to be done (87.2%), generally (63%) applying the same system. In 95% of occasions CPh refer the patient to a  medical service: 44% to the Hospital Emergency Department (HED) or Primary Care Health Center (PCHC) depending on the degree of BP elevation; 40% always to PCHC and 8% always to the HED. The remission is made after giving non-pharmacological advice from 41% of CPh (83% about diet, 25% about physical activity, and 85% about fulfillment), with 5% adding pharmacological advices. When primary care physicians and nurses are asked about the remission of patients from CPh because of elevated BP, 60% think that they use to be incorrectly remitted, mainly because of an overestimated measurement and alarmism induced by the pharmacist to the patient. On the other hand, a significant percentage of CPh think the primary care physician does not adequately value their role in the management of BP. Finally, table 2 illustrates the potential  impact on HED consultations of an improvement in the criteria for remissions from CPh considering that 40 to 45% of patients attended because of elevated BP are not referred from PCHC.

Discussion: CPh use very heterogeneous and subjective criteria for remission of uncontrolled hypertensive to medical services. They usually repeat the BP measurement and give nonpharmacological advices, although 5% of them also give pharmacological advices. There is a strong rejection from PCHC.

Conclusions: There are not objective and uniform criteria for the remission of uncontrolled hypertensive from CPh. Distrust is common between community pharmacists and PC professionals. An improvement in the  remission criteria could have a significant impact.

Rev Clin Esp 2012; 212: 450-451