Evaluation of impact of pharmaceutical care services on cardiologist adherence to hypertension Guidelines JNC 7: A critical prospect for rational use of drugs in Pakistan

Purpose: To assess the adherence of cardiologists to JNC7 and the impact of pharmacists in reducing clinical inertia by managing high blood pressure in the cardiology out-patient department of the Armed Forces Institute of Cardiology, Rawalpindi, Pakistan. Methods: This was a pre- and post-interventional prospective study in which data was abstracted from patients' history notes or prescription of selected patients at baseline and follow-up visits by applying a reliable tool. The data were abstracted again from the same patients to evaluate the cardiologists' adherence with the same parameters after 2,4 and 6 months. The sample size for this study was 116 patients and descriptive statistics were used for categorical variables. For the comparison of cardiologist's adherence to JNC7, means and paired `t' test were used at the level of 0.05 significance. Results: At baseline, the mean overall percentage of cardiologists' adherence to JNC7 was 46.7 +/- 18.9 %. This significantly improved to 98.8 +/- 6.0 % after 2 months of the pharmacist intervening by way of discussions with cardiologists. The cardiologists' adherence was further improved to 100 % after 4 and 6 months. Conclusion: Improvement in cardiologists' adherence to JNC 7 guidelines and involvement of the pharmacist enhance the documentation of BP goal, lifestyle modifications and uncontrolled BP. All these helps to overcome clinical inertia that ultimately leads to better BP control and rational use of medicines.