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 fact that crewmembers in the study were cognizant of the study could have affected their answers to the follow-up compliance questionnaire, i.e., response bias. However, before administering both the precounseling and postcounseling compliance questionnaires, the pharmacy officer stressed to each crewmember that his or her honest answer was needed. The pharmacy officer also reminded crewmembers that the questionnaire was anonymous. It was unfortunate that we were unable to administer a follow-up questionnaire to crewmembers on the USS Dwight D. Eisenhower and the USS Wasp, because this would have helped identify any bias inherent in the questionnaire.

During the planning phase of this study, we were informed that the USS JCS would be at sea for a 3-week period. Because the objective was to compare compliance before and after counseling by a pharmacy officer, the study objective was to compare compliance for identical 3-week periods. However, 4 days after getting under way, the at-sea period was decreased to 2 weeks. Therefore, the precounseling patient compliance data reflect patient compliance for a 3-week period, whereas the postcounseling data reflect patient compliance after a 2-week period. This disparity, although unfortunate, was completely unavoidable.

Because the pharmacist is most likely the last health care professional the patient encounters before taking a prescribed medication, the pharmacist is an extremely important member of a patient's health care team.' As was demonstrated in this study, the provision of health care is indeed a team effort. The pharmacy officer and the medical officer, working closely as a team, used their unique clinical skills to significantly increase patient compliance and to implement therapeutic interventions that helped optimize patient care in this patient population.

Before pharmacy officer counseling, patient compliance on the three ships was poor: 34%, 38%, and 17%. We contend that poor compliance was a problem not unique to the USS JCS. The rate of compliance measured on these three ships, along with the level of BP control measured on the USS JCS, was indeed poor. However, these compliance rates and the level of BP control are consistent with those reported in similar pharmacist intervention studies conducted at civilian institutions. 11,9, 11 With regard to crewmembers requiring chronic medications for disease states other than HTN, i.e., hyperlipidemia, reactive airway disease, migraine headache, and tuberculosis prophylaxis, there appears ample opportunity to improve clinical outcomes in these patient populations. Unfortunately, the duration of the study precluded measuring relevant intermediate clinical outcomes and the impact of pharmacy officer interventions on these clinical outcomes in these patient populations. However, given the number of therapeutic interventions initiated by the pharmacy officer, it is important to note that a subset of these patients were unstable and hence possibly at risk for a negative outcome while at sea. A similar study of longer duration could measure the impact of a pharmacy officer on intermediate clinical outcome indicators in these patient populations.