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

Results

Compliance

Before counseling, 35% of crewmembers on chronic medications on the USS JCS were compliant, 38% of the crewmembers on the USS Dwight D. Eisenhower were compliant, and 17% of crewmembers on the USS Wasp were compliant. On the USS JCS, we were able to administer the postcounseling compliance questionnaire to 40 of the 43 original crewmembers. Three were lost to follow-up. Significantly more crewmembers were compliant after the intervention (McNemar's test for symmetry; X 2 = 22.0, df = 1, p

To enhance the integrity of the compliance questionnaire, we wished to maintain anonymity regarding patient compliance. However, during the interview phase of the study, a number of patients admitted to being noncompliant. This information was provided unsolicited to the pharmacy officer by the patient. Although no specific data were maintained, it was noted that the most common reason provided was that the patient had neglected to obtain additional medication after he or she had exhausted his or her supply. It was also noted that 7 of 10 patients on isoniazid for tuberculosis prophylaxis admitted to noncompliance and that at least two patients admitted to not having taken their isoniazid for up to 2 weeks.

Pharmacy Officer-Initiated Therapeutic Interventions

Overall, the pharmacy officer recommended 34 therapeutic interventions, all of which were implemented and each of which directly resulted in a treatment change. Specific interventions are delineated by disease state (HTN, hyperlipidemia, reactive airway disease, and tuberculosis prophylaxis with isoniazid) in Tables 11 to V. Interventions were not required for crewmembers with other disease states. In addition to the interventions noted in Tables Il to V, two patients with HTN were taking the wrong dose of their prescribed medication and one HTN patient was taking the wrong medication.

Before intervention, one crewmember with reactive airway disease had been using his albuterol inhaler approximately 20 times (inhalations) per week. After intervention (an inhaled glucocorticoid was added), he had decreased his usage approximately 50%. In addition, of the seven crewmembers with hyperlipidemia, none had reached his or her low-density lipoprotein cholesterol goals as per National Cholesterol Education Program guidelines. The duration of this study precluded measuring the intermediate clinical outcome indicators in this patient population.

Blood Pressure Control

Before intervention, 11 of 26 hypertensive crewmembers (42%) had BP measurements at or below their BP goal (diastolic

We were able to obtain repeat BP measurements on 22 of the 26 hypertensive crewmembers. Four were lost to follow-up. Sixteen of 22 (73%) were noted to be at BP goal, Thus, there was a significant increase (McNemar's test for symmetry; X2 = 6.0, df = 1, p

Discussion

The statistically significant increases of 58% in patient compliance and 31 % in number of patients at BP goal can be attributed to the counseling and therapeutic interventions initiated by the pharmacy officer. However, there are some limitations to this study that need to be considered.