Patient compliance and blood pressure control on a nuclear-powered aircraft carrier: Impact of a pharmacy officer

Military Medicine, Feb 2000 by Brouker, Mark E

The impact of a pharmacy officer on patient compliance and blood pressure control on a deployed nuclear-powered aircraft carrier for a 2-week at-sea period was evaluated. Before any counseling by a pharmacy officer, 43 crewmembers on chronic medications anonymously completed a compliance questionnaire. The pharmacy officer then counseled these crewmembers. A follow-up compliance questionnaire was completed 2 weeks later. After counseling, compliance had increased 58% (p

Introduction

About one-half of the 2 billion prescriptions filled each year are taken incorrectly and result in one-sixth of all hospital admissions, one-fourth of all nursing home admissions, onefourth of all malpractice suits, and 2.5 million medical emergencies each year.1 Clinical pharmacy services have been shown to influence patients' ability and motivation to adhere to treatment plans through educational and motivational means and have helped to alleviate the negative outcomes of patient noncompliance.2-13 In addition, the clinical benefits of pharmacist-initiated therapeutic interventions in optimizing patient care are well documented in the literature. 14-16

These impressive results were accomplished at civilian health care facilities in civilian patient populations. The assessment of similar clinical initiatives in a patient population of active duty armed forces personnel in an operational environment, i.e., on a deployed U.S. Navy warship, has yet to be performed. Because a medical emergency on a deployed warship is an outcome that must be avoided, we elected to study the impact of a pharmacy officer (a registered pharmacist who is a commissioned naval officer) on patient compliance and intermediate clinical outcomes while on a deployed nuclear-powered aircraft carrier (CVN) for a 2-week at-sea period. A review of the literature revealed that a study of this nature had not been attempted in this patient population in such an environment.

There are 138 active duty pharmacy officers in the U.S. Navy. These officers are stationed at shore-based military treatment facilities throughout the world. There are currently no pharmacy officer positions on warships during peacetime. Furthermore, because of the increasing pharmacy workload at these shore-based military treatment facilities, there has been a diminished pharmacy officer presence pierside to provide support to these warships. The pharmaceutical care needs of crewmembers on warships in peacetime are met by highly trained pharmacy technicians.

The USS John C. Stennis (CVN 74) is one of the newest CVNs in the U.S. Navy fleet of warships. While deployed, it carries approximately 6,000 men and women. The medical department on the USS John C. Stennis (JCS) has 59 beds, including 3 critical care beds, and a staff of 42. The staff consists of six medical officers (physicians who are commissioned naval officers), including a surgeon and an anesthesiologist, a physician assistant, a nurse, one pharmacy technician, and other medical paraprofessionals.

In March 1998, the USS JCS proceeded by high-speed transit to the Persian Gulf area of operations as part of its first 6-month deployment. In January 1998, it participated in a 2-week joint task force exercise in the Caribbean Sea to prepare for that 6-month deployment, This exercise allowed us to measure the impact of a pharmacy officer on patient compliance and other intermediate clinical outcomes through the assignment of a pharmacy officer to the ship.

Although the vast majority of crewmembers on a CVN are young and healthy, there is a population of crewmembers on these vessels who require chronic medications. It was this patient population- crewmembers on chronic medications-that we elected to focus on for our study.

The objectives of this study were (1) to establish whether medication administration patterns of crewmembers on a deployed U.S. Navy warship would improve significantly after counseling by a pharmacy officer, and (2) to establish whether therapeutic interventions initiated by the pharmacy officer would significantly increase blood pressure control in crewmembers diagnosed with hypertension (HTN).

Methods

Identifying Crewmembers on Chronic Medications

In an effort to identify those crewmembers on chronic medications, an entry was placed in the ship's Plan of the Day (a daily communique distributed throughout the ship; information contained in the Plan of the Day is considered an official order) that instructed crewmembers on chronic medications to contact the ship's pharmacy department. The entry ran in the Plan of the Day for 5 consecutive days. Appointments with the pharmacy officer were scheduled for these crewmembers.

Measuring Compliance

Before any counseling by a pharmacy officer, all crewmembers on the USS JCS identified as being on chronic medications were asked to complete an anonymous self-reported questionnaire (Table 1). This questionnaire was completed by these crewmembers while the ship was at sea. A crewmember providing a .yes" answer to any of the questions was categorized as "noncompliant," whereas a crewmember needed to answer all questions "no" to be categorized as "compliant." Because no historical data of this nature exist, we elected to present the questionnaire to crewmembers on two additional warships to verify that any level of noncompliance measured on the USS JCS was not a problem unique to that ship. Thus, the questionnaire was administered to crewmembers on chronic medications assigned to the USS Dwight D. Eisenhower, a ship of similar class as the USS JCS, and to the USS Wasp, an amphibious assault ship with a crew population of approximately 3,000. The compliance questionnaire was presented to crewmembers on these two ships while pierside in Norfolk, Virginia.