Pharmacists to improve hypertension management: Guideline concordance from North America to Europe
Bibliographic record
Abstract
Hypertension is highly prevalent but remains poorly controlled in Canada, the United States and European countries.1-4 Reasons include clinical inertia, patients’ limited access to health care, lack of awareness or underestimation of the importance of lifestyle factors and nonadherence to blood pressure (BP)–lowering medication.1 Challenges exist at every level of hypertension management, and accordingly, solutions for improving hypertension control rates should be multilevel. One innovative solution for improving hypertension care is shared care through teambased care (TBC). TBC is a coordinated model of shared care involving different health care professionals, such as physicians, pharmacists, nurses or other health care professionals, working in collaborative partnership, each with their own expertise.5 An important member of the team is the pharmacist, who is a valuable asset to improve hypertension management given his or her accessibility and drug therapy xpertise.6 Several meta-analyses of randomized trials have shown significant reductions in BP when pharmacists were involved compared to usual care.7-9 In addition, pharmacist-led interventions appear to be cost-effective. Indeed, Marra et al.10 showed a net cost savings of $CDN 15.7 billion if only 50% of Canadians had their hypertension care provided by a prescribing pharmacist, compared to usual care.11,12 Recent guidelines on hypertension management, notably the 2017 guidelines from the American College of Cardiology Foundation and American Heart Association (ACC/AHA), recommend TBC for the first time.13 Moreover, the ACC/AHA recommendations are in line with recent commendations of Hypertension Canada and the European Society of Hypertension.14,15 In this brief review, we discuss the recommendations for TBC for hypertension management in recent American, Canadian and European guidelines and pinpoint roles and responsibilities that fall within the scope of care provided by a pharmacist.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.050 | 0.142 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.006 | 0.004 |
| Open science | 0.003 | 0.006 |
| Research integrity | 0.004 | 0.006 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".