LOYAL project uses technology and multidisciplinary support to help patients in Quebec reach BP targets

BACK TO INDEXEven though the effects of optimal management of blood pressure (BP) on mortality and morbidity rates have been clearly established, the majority of hypertension patients do not properly monitor their condition.Knowing this, a team at the Centre hospitalier de l’Université de Montréal Research Centre (CHUMRC) set out in 2004 to implement a multidisciplinary program centred around enabling patients and healthcare providers to collaboratively monitor and control BP rates.The LOYAL (Lowering blood pressure by improving cOmpliance with hYpertension therapy through the Assistance of technoLogy-enhanced tools) study, with funding support from Pfizer Canada, recruited men and women over 18 years of age whose average 24-hour BP was >130/80, with average daily values of >135/85 mmHg. A total of 223 patients were randomized into two groups: a control group that received the typical model of medical care; and an intervention group that used home blood pressure monitors and reported their readings to an automated phone support system, which also gathered feedback on adherence to medication and reminded patients to renew their prescriptions.“If a patient entered a high BP reading, the system would automatically alert the study nurse, who would then call the patient and refer him or her, if necessary, to the appropriate healthcare outlet—either the community pharmacist, the physician or the emergency room,” explains Lyne Lalonde, associate professor at the Université de Montréal Faculty of Pharmacy, and co-investigator for LOYAL.Study outcomesOver the course of 12 months, the system generated 4,617 calls to collect BP values and observance data, an average of 42 calls per patient in the intervention group. Nurses placed 209 calls in response to a system-induced alert, an average of 1.9 calls per patient in the intervention group. The average length of the call was 7.5 minutes. Overall, the intervention group saw a significant decrease in BP over the course of a year in comparison with the control group, with an average drop of 6.0 mmHg in both systolic and diastolic BP based on several readings taken over a 24-hour period.“Hypertension is a major problem and few hypertensive patients—a meagre 25% in North America—adequately control their BP,” says Dr. Marie-Thérèse Lussier, co-principal investigator of the LOYAL program and associate professor at the Faculty of Family and Emergency Medicine at the Université de Montréal. Within the context of the LOYAL study, 46% of patients in the intervention group had reached their blood pressure target after one year.The results raise awareness not only of the importance of frequent BP readings, but also of the need for providers to work collaboratively in order to make that happen. “A retrospective analysis of numbers that patients noted weeks and months ago don’t allow for immediate action,” says Lussier. “We need a multidisciplinary approach, to step out of the doctor’s office and reach out to other healthcare professionals who have more frequent contacts with patients—like pharmacists, who see patients at least once a month, during prescription renewals.”The shortages of physicians and other healthcare providers in many communities underline the need for innovative team approaches like thatof LOYAL.Lalonde concurs, saying such interprofessional projects provide an ideal avenue for pharmacists to make full use of their skills and expertise.“Initiatives like LOYAL point to the kind of follow-up and primary care that are within pharmacists’ reach. Adjusting medications may not be a sound investment of a physician’s time or their expertise; they should be seeing new patients and making diagnoses.”Keys to SuccessUse technology to facilitate communication and patient involvement. Automated phone and online systems can easily link physicians and other health professionals who are not co-located, as well as their patients.Mutual trust and sharing of data between providers (i.e., diagnostic information and medication profiles) improve the quality of care outside of physician visits and help mitigate physician shortages.Selfcare is the central goal of interprofessional care, particularly for patients with chronic conditions. A patient’s ability to effectively monitor his or her condition outside of healthcare visits is vital to improved outcomes.Lalonde adds that community pharmacists tend to be isolated and encourages physicians to invite them to conferences and other meeting opportunities.While LOYAL’s design called for an interprofessional effort that was mostly mediated by technology, even this ‘virtual’ contact between physicians and pharmacists is beneficial. The key to the design’s effectiveness was a shared confidence between the physician (who shared diagnosis information) and pharmacist (who shared medication data), in a mutual effort to improve patient care and outcomes. “Any collaboration is easier when it rests on a mutual confidence,” says Lussier.While the collaborative component was vital to the success of LOYAL, the program’s ability to put patients at the centre of their own treatment plan was of even greater significance to Lussier. “We were able to get better control of BP levels and have a higher percentage of patients with their hypertension in check without increasing doctor visits. It is the selfcare theory at work.”For more information:•Dr. Marie-Thérèse Lussier, Faculty of Family and Emergency Medicine at the Université de Montréal, (450) 668-1010 ext. 2742 or mtlussier@videotron.ca•Lyne Lalonde, Université de Montréal Faculty of Pharmacy, (514) 343-6111 ext. 5315 or lyne.lalonde@umontreal.caWebsite: www.recherchepl.ca

LOYAL project uses technology and multidisciplinary support to help patients in Quebec reach BP targets

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