Complexity of patients with hypertension cared for by clinical pharmacist practitioners in the Veterans Health Administration
Ann M Borzecki, Guneet K Jasuja, Shirley Qian, Ndindam Ndiwane, Shawn McFarland, Heather L Ourth, Megan M McCulloughAbstract
Purpose
Clinical pharmacist practitioners (CPPs) are well suited to manage complex patients, such as those with hypertension. However, there is limited information about the complexity of patients managed by CPPs with respect to chronic disease. This study compared the clinical complexity of patients with hypertension managed by CPPs to that of patients managed by other providers.
Methods
In this cross-sectional study, patients with hypertension at 19 Veterans Health Administration (VA) sites during fiscal years 2024 to 2025 were classified by CPP visits into those with more than one visit (“ongoing CPP care”), those with one visit (“consultative CPP care”), and those with no visits (“no CPP care”). Patient complexity was assessed using 7 hypertension-related measures indicating need for more management time and resources. Logistic regression models adjusted for age, sex, race, and marital status were generated to analyze differences between the groups.
Results
Compared to patients in the group with no CPP care, patients with ongoing CPP care had significantly higher complexity as measured by hypertension medication use (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.09-1.70), other medications associated with hypertension (aOR, 1.66; 95% CI, 1.26-2.18), hypertension complications (aOR, 1.60; 95% CI, 1.29-1.98), and medication nonadherence (aOR, 1.36; 95% CI, 1.06-1.75). Similar findings were noted for patients with consultative CPP care vs those with no CPP care. A composite complexity score of all 7 measures indicated that patients with ongoing (aOR, 1.89; 95% CI, 1.54-2.32) and consultative (aOR, 1.88; 95% CI, 1.57-2.24) CPP care were significantly more complex than patients with no CPP care.
Conclusion
CPPs manage patients with hypertension who are more complex than those managed by other VA providers. These findings underscore the importance of CPPs in improving patient outcomes through comprehensive medication management.